JANUARY

SWITZERLAND
Hospitals: About 70 percent of the 293 acute inpatient hospitals (in 2013) are public or publicly subsidized
private hospitals (SFOS, 2015b). For services covered by SHI and billed through a national diagnosis-related
group (DRG) payment system, hospitals 2 receive around half (45%–55%) of their funding from insurers (Swiss
Conference of Cantonal Health Ministers, 2015b). The other half is covered by cantons and communes, or, in
case of additional services, by private health insurance. There are no arrangements for bundled payments to
include entire episodes of care are not used.
Cantons are responsible for hospital planning and funding, and are legally bound to coordinate plans with
other cantons. The introduction in 2012 of free movement of patients between cantons under the DRG system
has reduced cantonal fragmentation. Remuneration mechanisms depend on insurance contracts; as a
consequence, fee-for-service is still possible for inpatient services not covered under SHI. Hospital-based
physicians are normally paid a salary, and public-hospital physicians can receive extra payments for seeing
privately insured patients.
Mental health care: Psychiatric practices are generally private, and psychiatric clinics and hospital departments
are a mix of public, private with state subsidies, and fully private. There is also a wide range of socio-psychiatric
facilities and daycare institutions that are mainly state-run and -funded.
Psychiatric hospitals or clinics normally provide a full range of medical services like psychiatric diagnostics and
treatment, psychotherapy, pharmaceutical treatment, and forensic services. Often, the socio-psychiatric facilities
and daycare institutions offer the same medical services as the clinics, but normally treat patients with less acute
illnesses or symptoms. The main field of activity of psychiatric practices is psychotherapy that can be
supplemented by pharmaceutical treatment. The provision of psychiatric care is not systematically integrated
into primary care. Prices for outpatient psychiatric services are calculated using TARMED, while psychiatric
inpatient care prices are usually calculated as a daily rate.
Long-term care and social supports: Services are provided for inpatient care (in nursing homes and institutions
for disabled and chronically ill persons) and for outpatient care through Spitex. In some cases admission is
possible only through a hospital or by approval from an admission authority. Palliative care provided in
hospitals, in nursing homes, in hospices, or at home is not regulated separately in SHI, so coverage of services
is similar to acute services in the respective provider setting. There is no provision of individual or personal
budgets for patients to organize their own services.
Inpatient long-term somatic and mental services are covered by SHI, but are highly subsidized by cantons. For
services in nursing homes and institutions for disabled and chronically ill persons, SHI pays a fixed contribution
to cover care-related inpatient long-term care costs; the patient pays at most 20 percent of care-related costs
that are not covered, and the remaining care-related costs are financed by the canton or the commune. Longterm
inpatient care costs totaled CHF12.0 billion (USD8.8 billion) in 2013, representing 17.4 percent of total
health expenditures. Around one-third of these costs (32.0%) were paid by private households, one-quarter
(24.1%) by old age and disability benefits, 18.4 percent by SHI and other social insurances, and the rest by
government subsidies (25.5%). Of the 1,580 nursing homes (as of 2013), 29.6 percent are state-operated and
-funded, 29.6 percent are privately operated with public subsidies, and 40.8 percent are exclusively private
(SFOS, 2015c).
Almost half of total Spitex expenditure of CHF2.0 billion (USD1.4 billion), as of 2013 (SFOS, 2015d), is financed
by government subsidies (47.5%). SHI and the other social insurances covering the cost of medically necessary
health care at home made up roughly one-third (30.0%). The rest (22.6%), devoted mainly to support and
household services, was paid out-of-pocket, by old age and disability benefits, by VHI, and by other private
funds (SFOS, 2015a). There is no legal basis for financial support for informal help or family caregivers. Most
Spitex organizations are subsidized nonprofit organizations (85% of personnel), while the remaining 15 percent
are nonsubsidized for-profit organizations (SFOS, 2015d).
2 This includes private hospitals that receive public subsidies if the cantonal governments have need of their services to
guarantee a sufficient supply for Sweden.
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The Commonwealth Fund