Managed Care Swiss Style – will voters buy it?

The World Health Organisation Annual Assembly was in Geneva last week. I am sure great issues were discussed – Le Temps asked if the planned reorganisation had any traction. Accusations were made that the organisation had been captured by private interests, lost its independance and that the whole effort should be stopped for a big rethink. (Bill and Melinda Gates gave $220m to the 2010-11 budget.) Against that, Le Temps suggests,  Margaret Chan elected by 98% of the votes to head up the WHO for her second and last term, may chose to pick the pace of the reforms to see what she can do before leaving in 2017. Let us know, someone.

Common concerns in the world of health

It would be sad if the main pre-occupation of the WHO over the next few years was its management systems and it became as inward-facing as most national healthcare systems. The NHS is so resolutely inward facing contemplating its own chronic intestinal complaints that it is a surprise to be reminded that there a lot of people trying to pick up stuff from other healthcare systems and trying to solve or at least manage the problems common to them all – the rise in both demand and expense. How to square that circle?

Feeling the pinch, even in Switzerland

Even the Swiss with their comprehensive healthcare system are facing up to the fact that insurance premiums cannot keep increasing every year. And what is the latest phrase on the lips of insurers and clinicians here in Switzerland? Managed Care. The Swiss especially those in the French-speaking bit are used to finding and choosing their own doctors. The insurers want to keep the lid on premiums and are now trying to persuade their customers that there is another way that offers good quality care at a lower cost. The deal on the table is that if Swiss citizens give up free choice of doctors and take the one on offer from their insurers, they will get a cut in insurance premiums.

Probably NO – but good to vote?

There is a vote about it on June 17th with the current odds in favour of the proposition being rejected. The initiative will join the seven previous attempts to reform healthcare – in the bin. The issue has united the left and the far right with both committed to rejection and guess what – the doctors cannot make up their minds. No threats to withdraw their labour as yet.

Selling change to healthcare users seems to be a political no-no wherever or whoever is trying to do it. It would appear that insurance companies are little better than doctors in selling change. Is the root cause an unfamiliarity amongst all parties described by the Kings Fund in a recent report on why patient preferences matter? The KF points out the consequences of what the report calls a lack of skills in understanding what patients want, labelling the outcome as a  “silent misdiagnosis” of patients’ preferences. Will the Swiss getting a vote on this sort of issue make for clearer preferences and better outcomes? Or will the insurers keep trying in the hope that people will ‘see sense’ the ninth time around?



  1. Colin Adamson says

    See the topic debated on the Tribune de Geneve site this Thursday 7th June:

    Réseaux de soins: panacée ou placebo?

    Juguler la hausse des coûts en améliorant la qualité des soins: c’est l’ambition de la modification de la LaMal soumise au vote le 17 juin. Or les sceptiques prédisent une médecine à deux vitesses et la mainmise des assureurs sur le système de santé. Le Dr Bertrand Buchs, député PDC, et le Dr Marc-André Raetzo, cofondateur du réseau Delta, débattront du «managed care» ce jeudi à 12h30

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