JANUARY

What are the key entities for health system governance?
SWITZERLAND
Since health care is largely decentralized, the key entities for health system governance exist mainly at the
cantonal level. Each of the 26 cantons has its own elected minister of public health. Supported by their
respective cantonal offices of public health, ministers are responsible for licensing providers, coordinating
hospital services, subsidizing institutions, and promoting health through disease prevention. Their common
political body, the Swiss Conference of the Cantonal Ministers of Public Health, plays an important coordinating
role. At the cantonal and the national level, market pressure, i.e., from competition, is felt most by hospitals and
by health insurers (OECD, 2011).
The main national player is the FOPH, which, among other tasks, supervises the legal application of mandatory
SHI, authorizes insurance premiums offered by statutory insurers, and governs statutory coverage (including
health technology assessment) and the prices of pharmaceuticals. Other cost-control measures are shared with
cantonal and communal governments. The FDHA legally defines the SHI benefits basket. Professional selfregulation
has been the traditional approach to quality improvement.
Prices for outpatient services are set in the fee-for-service scale TARMED, which defines the relative cost weights
of all services covered by SHI on the national level and is authorized by the Swiss Federal Council. TARMED
values can vary among cantons and service groups (physicians, outpatient hospital services) as negotiated
annually between the health insurers’ associations and cantonal provider associations, or are set by cantonal
government if the parties cannot agree. For inpatient care, the Swiss national DRG system has been in use since
2012. The nonprofit corporation SwissDRG AG is responsible for defining, developing, and adapting the
national system of relative cost weights per case.
In addition to the responsibilities of the FOPH and cantonal governments, Health Promotion Switzerland,
a nonprofit organization financed by SHI, is legally charged with disease prevention and health promotion
programs and provides public information on health. A national ombudsman for health insurance and the
Association of Swiss Patients engage in patient advocacy.
What are the major strategies to ensure quality of care?
Providers must be licensed in order to practice medicine, and are required to meet educational and regulatory
standards; continuing medical education for doctors is compulsory. Local quality initiatives, often at the provider
level, include the development of clinical pathways, medical peer groups, and consensus guidelines. However,
there are no explicit financial incentives for providers to meet quality targets.
The Quality Strategy, approved by the SFC at 2009, takes a broad conceptual approach with different fields
of action, including the implementation of a national pilot program by the Swiss Foundation for Patient Security
on medication safety in acute-care hospitals, a pilot program to reduce hospital infections, and the publication
of quality indicators for acute-care hospitals. Quality-control mechanisms usually do not involve information from
registries or patient surveys. Registries are organized by private initiatives or cantons, such as the cantonal
cancer registries.
At the end of 2013, the SFC mandated a task force led by the cantons and the Swiss Confederation (the
Dialogue on National Health Policy) to work out a national strategy for the prevention of noncommunicable
diseases (NCDs) by 2016. The strategy aims to improve the health competence of the population and promote
healthy living conditions. The National Health Report (Obsan, 2015) discusses the growing number of case
management programs for chronic illnesses.
International Profiles of Health Care Systems, 2015 165