Dr. Fritz Georg Fark – Head of Delegation

Dr. Daniel Widmer – Member

Dr. Carlos Beat Quinto – Member

General Practice in Switzerland

Switzerland has a liberal health care system. It is a system with primary and secondary health care. Patients have a free choice of general practitioner and specialist but not of hospital (necessity to be cured in a hospital in the same canton). Swiss GP do not serve as gatekeepers to higher specialised care. A probable revision of the law will possibly change this situation like free choice of hospital. The introduction of managed care is discussed and some systems of integrated care are existing now principally in the east part of Switzerland.

A few statistics:

The swiss health system costs 55 336 millions SFRS yearly. The hospital treatments represent 45.9% of that total, the ambulatory care 31.3%, medicaments 10.3% (OFS 2007). The costs of practitioners (for general practitioners and specialists of the private sector) has increased by 17.58% from 1995 to 1999 while the non-stationary hospital services (the public sector) has increased by 47.5% in the same time (1).

Professional associations:

The general practitioners do not include all doctors engaged in primary care, of whom internists and paediatricians are also part.

GPs, internists and paediatricians all have a specialists status, since in all three cases the length of the post-graduate training period is five years, following the medical studies. Recently (2009) a new society has been created, “Medecins de famille Suisse (MFS)” (http://www.medecinsdefamille.ch/ ) to defend the 3 societies (Swiss Society of General Medicine (SSMG), Internal Medicine (SSMI) and paediatrics (SSP). At the UEMO, the Swiss Society of General Medicine (SSMG) is represented jointly with the FMH (Foederatio Medicorum Helveticorum), which is the umbrella organisation of all Swiss doctors. A new title has been created (2010) regrouping those of internal and general medicine: general internal medicine.

On the political level:

A revision of the law on health insurance (LAMal) is discussed. The most notable change may be the “abolition of the obligation to contract” or the “law on managed care”: until now, the health insurance companies had to reimburse all doctors, which was called “the obligation to contract”. It is very possible that under the terms of the revision, the insurance companies would be able to choose which doctors they will reimburse or with the law on managed care to select the networks of doctors (still in discussion at the Parliament – 2011). Some generalist practitioners see this modification positively, guessing that the insurance companies will decide to prioritize the GPs, offering them the role of gate-keepers in a system of networks. Others think that by establishing their choice on economic criteria of cost per case, the insurance companies may eliminate the most expensive GPs, who accept to treat patients with large co-morbidities, especially the psycho-social cases and the elderly. That would create discrimination in the society: by limiting the choice of the doctor, a two-speed medical care system may appear. In Switzerland it is possible to ask for a referendum when a sufficient amount of citizens wish for a new law to be submitted to vote or to present an initiative. Such an initiative is now presented by the association MFS to reinforce the role of family physician.

A new medical tariff is entered in force on the first of January 2004, on the national level, abolishing the diverse cantonal tariffs. The intention behind creating this tariff was to privilege the intellectual or relational act to the detriment of the technical acts, and to have each doctor be paid equally for the same service, regardless of his/her specialized area of medicine. In so doing, the time of consultation was divided in slots of five minutes, which enables administrative control of the content. The complexity of the measure seems to indispose a certain amount of colleagues who were first pleased by the idea of a single tariff. Other existing risks are that consultation time may be reduced in a will of rationing, or that a global budget would be introduced.

Dr Daniel Widmer, Head of UEMO Swiss Delegation – July 2011

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