Swiss wrestle with rising health bill

Hospitals are a big cost burden Keystone

Health costs in Switzerland have increased by four percent to SFr48 billion ($37.7 billion), according to latest figures, making them the second highest in the world.

The news comes amid fresh government proposals to cut the country’s health bill. One option, say experts, would be to close 85 per cent of hospitals.

The Federal Statistics Office said on Friday that the rise in health costs in 2002 was in line with the five-year average.

Officials blamed higher costs on more expensive medication, an increasing number of doctors and new forms of treatment.

The government, which is battling to rein in spiralling health costs, submitted its latest proposals on Wednesday. They include reducing the number of doctors and increasing patients’ contributions to medical bills.

Switzerland’s health costs are among the highest in the world. Figures from the Organisation for Economic Cooperation and Development (OECD) show they are equivalent to 10.9 per cent of Gross Domestic Product (GDP).

This puts the country in second place behind the United States at 13.9 per cent of GDP and compares with only 9.7 per cent of GDP in neighbouring France.

Too many hospitals

One idea for slashing the health bill is to radically cut the number of hospitals in Switzerland.

Willy Oggier from the Swiss Society for Health Policy says there is a surplus of hospitals in Switzerland.

“There are between 20 and 30 per cent too many hospitals [in Switzerland],” said Oggier, who added that there were too many small hospitals and teaching hospitals for such a small country.

Some cantons, such as Bern and Fribourg, have already announced they are looking into reducing the number of hospitals, especially those offering short-term care.

But some experts go even further, arguing that only a severe cut in the number of hospitals would help to stem the problem.

Radical

In a study on hospital planning conducted while at the University of Lausanne, health specialist François de Wolff argued that the number of hospitals should be cut from 260 to just 40.

He maintains that 40 hospitals, each containing between 300 and 600 beds, would meet the needs of the population.

Using demographic and road network data, Wolff says no one would be more than 60 minutes away from a hospital.

Wolff admits the plan looks “very extreme”, but he insists it makes financial sense.

“Around 75 per cent of hospitals today have less than 135 beds and small hospitals cost much more to run than bigger hospitals with 150 or more beds. So you are being much more economic – it’s an economy of scale,” de Wolff told swissinfo.

Quality of care

De Wolff added that such a drastic reduction in the number of hospitals would not affect the quality of patient care.

“A very important part of my study was to show that even if you go down to 30 or 40 hospitals, everybody in Switzerland could get to a hospital in an average time of less than one hour,” he said.

One of the sources for his study was a report by the Swiss Conference of Cantonal Ministers of Public Health, which suggested that cantons only needed to provide 3.2 beds per 1,000 inhabitants.

This figure stood at 6.2 beds per 1,000 inhabitants in 2001, according to World Health Organization statistics.

De Wolff believes his proposals could save the country SFr2 billion. However, he concedes in his report that such a radical change would be difficult to carry out within the present hospital system.

Unrealistic

Franz Wyss of Swiss Conference of Cantonal Ministers of Public Health agrees that Switzerland has too many hospitals but says it could take years to reach the right balance.

“The results [of the study] are quite frightening if you think we should go down to only 40 hospitals,” Wyss told swissinfo. “But if you have 20 or 30 years to plan it, it would be quite reasonable to take this approach.”

But he says that the SFr2 billion savings figure is unrealistic because there would be a huge write-off in terms of investments and infrastructure.

Attempts to cut the number of hospitals have already encountered opposition from patients’ organisations and doctors, who are worried that the quality of health care in Switzerland could suffer as a result.

And although all parties agree that health costs are too high, no one has yet been able to come up with an acceptable solution.

The government is keen to resolve the problem and hopes that Wednesday’s measures will be accepted by a sceptical population.

The government’s last attempt to reduce the health bill was rejected by parliament in December after three years of debate.

swissinfo, Isobel Leybold

Key facts

Swiss health care costs rose by 4% in 2002 compared to 2001.
They cost SFr48 billion in 2002, compared to SFr46,1 billion in 2001.
Health care costs were the equivalent of 10.9% of the GDP in 2001, putting Switzerland in second place after the US.
Neighbouring Germany’s cost were 10.7% of GDP but France’s costs only made up 9.7% of GDP.