The Swiss healthcare system is one of the world’s most extensive with respect to its availability of care for the general population and its expense relative to gross domestic product. A 2005 study by the Organisation for Economic Cooperation and Development found that the Swiss healthcare system is funded with about 11 percent of the nation’s GDP. In net figures this corresponds to approximately $48 billion.
This financial burden is distributed among three collectives: Private households (66 percent, mostly through mandatory healthcare insurance), the state (27.3 percent, direct and indirect subsidies deriving from tax earnings) and private enterprises (6.7 percent, mostly through payments to mandatory funds covering accident insurance, and pensions for elderly and disabled individuals).
Health insurance is mandatory for every citizen in Switzerland. Public funding provides partial or full subsidies, depending on an individual’s ability to fund his or her own insurance. Therefore, every citizen is eligible for treatment in one of Switzerland’s publicly operated hospitals. There are 12 public hospitals that offer cranial and/or spinal neurosurgical care, and among these are five university hospitals in Basel, Bern, Geneva, Lausanne and Zurich.
In addition to these centers, there is wide availability of private inpatient clinics and privately operating doctors (52 individuals in 2007), who mostly focus on spine surgery. In 2007, the Swiss Medical Association listed 105 neurosurgeons as medical specialists, leading to a ratio of 1 neurosurgeon per approximately 71,400 inhabitants.
There are no direct figures that reliably indicate the Swiss public’s satisfaction with the delivery of medical care in general and neurosurgical care in particular. Yet in 2002, a survey by the Federal Office of Public Health found that 85.8 percent of the interviewed individuals (16,141 permanent residents older than 15) felt their state of health to be “good” or “very good.” The relationship between this subjective perception and the quality and availability of medical care in Switzerland remains open for discussion.
After graduation from university there are no specific entry level tests for further specialization, and the graduation scores are not considered in the allocation of residencies. In many instances applicants for residencies in neurosurgery are advised to acquire basic surgical skills in general surgery or to gain experience in a closely related discipline like neuroradiology prior to their engagement as a resident in neurosurgery.
The legal system in Switzerland differs quite substantially from the legal system in the U.S. With respect to medical practice it is most notable that the term “punitive damage” has no equivalent in Swiss courts. What an aggrieved party might expect as an indemnity for damages is in fact quite narrowly defined. Additionally state liability laws basically devolve the liability of a medical practitioner in a public hospital unto the state itself, and the state is made liable for its civil servants (the doctors) and their actions. It is therefore quite safe to say that a neurosurgeonâs life in Switzerland can be relatively free of legal hassles and the astronomical costs of insurance to prevent them.
Helmut Bertalanffy, MD, is director of the neurosurgery department, and Nicolas Koechlin, MD, is a neurosurgeon at University Hospital, Zurich, Switzerland. The authors reported no conflicts for disclosure.
For Further Information
- Eco-Health, 2005, Organisation for Economic Co-operation and Development, www.oecd.org
- Swiss Code of Obligations, Article 61: Liability of officials and public employees, www.wipo.int/clea/en/details.jsp?id=681
- Swiss Federal Statistical Office, www.bfs.admin.ch/bfs/portal/en/index.html