Switzerland / Liechtenstein
Landlocked at the crossroads of northern and southern Europe and a country that espoused neutrality, Switzerland is a prosperous and modern market economy with low unemployment, a skilled labour force, and a per capita GDP among the highest in the world. An independent federal republic administered across 26 cantons, four different languages are spoken: German, French, Italian, and Romansh. Switzerland has a highly developed health care system which upholds the principles of universality and equality through means such as compulsory health insurance. Positioned between Switzerland and Austria is the German-speaking principality of Liechtenstein, which has a customs and monetary union with Switzerland.
GDP per capita
Swiss Franc (CHF)
When looking at healthcare expenditure as a percentage of GDP, an international comparison puts Switzerland second behind only the USA at 11.9%. Responsibility for the provision and funding of Switzerland’s universal health care system lies mainly with the 26 cantons. Most hospitals are owned or controlled by cantons and municipalities. In Switzerland, mandatory health insurance, the basic social insurance, is paid for by all residents. In the event of an illness, the basic health insurance ensures that the cost of medical treatment is covered. Everyone is individually insured and is free to choose his or her health insurer from around 60 privately organized health insurers that offer basic insurance coverage. Most funding comes from this and the cantons, although out-of-pocket costs, such as non-reimbursed medicines, contribute significantly to the health system. Supplementary health insurance plans primarily cover benefits regarding greater freedom than provided by mandatory health insurance, for example in the choice of doctor or hospital.
The pharmaceutical industry is the flagship of Switzerland, providing around one in 15 jobs in industry. As a driving force of the Swiss economy, the sector was responsible for more than a third of the country’s GDP growth between 2010 and 2020. It contributes to 5.7% of the GDP of Switzerland and to 30% of the country's exports. Since Switzerland is not a member of the European Union, it has its own drug regulatory authority and is not affiliated to the European Medicines Agency (EMA). The Swiss agency, Swissmedic, is responsible for the approval of new medicines and for monitoring of the pharmaceutical market in Switzerland. Before reimbursement is possible, pharmaceutical companies first have to apply to the Federal Office of Public Health for inclusion in the Specialties List (SL) and to provide evidence that the medicines are effective, suitable and efficient. Prices are determined by means of therapeutic referencing and a comparison with prices in other countries.
Pharmaceuticals are dispensed in pharmacies, hospitals, drugstores and, in certain cantons, also by doctors. For the most recent year available, 2020, the pharmaceuticals market in Switzerland had a market value of CHF 6.3 billion at ex-factory prices (+2.9% year-on-year) on a volume of 183 million packs.
Switzerland has an excellent health system and the public is currently satisfied with the service it receives. However, in the coming years, its health system faces a number of challenges, including:
The number of elderly people is constantly rising, and this means a rise in chronic illnesses, whereas current structures focus strongly on dealing with acute care and in-patient care, rather than preventing disease, the long-term care of people with chronic conditions and on the last stages of life.
The costs of health care will continue to rise due to demographic developments and medical and technical advances, yet high health insurance premiums are already a considerable financial burden for a lot of people.
To control pharmaceutical costs, coverage decisions on all new medicines are subject to an evaluation of their effectiveness and cost. Efforts are being made to reassess the prices of one-third of existing drugs every year. Depending on national market volume, generics and biosimilars must be sold for 20 percent to 50 percent less than the original brand. In addition, consumers pay higher coinsurance for brand-name drugs if generics exist. Pharmacists are reimbursed flat amounts for prescriptions, so they have no financial incentive to dispense more-expensive drugs.
Laurent Massuyeau & Michele Genini
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