Switzerland has an effective healthcare system and is considered as a mandatory private social health insurance system. The Health Insurance Act (HIA) makes it mandatory for citizens to buy health insurance. The Federal and the Cantonal governments provide the subsidy to low-income individuals.
The administration of the healthcare is divided at federal, cantonal and at municipal levels.
In Switzerland healthcare, cantonal bodies play a major role.
Federal government responsibilities: It is responsible for financing. The revenues are obtained from mandatory health insurance and other social insurances. It is also responsible for maintaining the quality and safety of pharmaceuticals and medical devices, encouraging the research.
Cantonal bodies: There are 26 cantons in Switzerland which are responsible for licensing providers, coordinating the hospital services and providing the subsidy for premiums.
Municipalities: They are responsible for long terms of care and other supporting systems.
The funding for healthcare is through private insurance
Federal council: It consists of 7 members. They are elected by United Federal Assembly and their term is 4 years.
Federal Department of Home Affairs: Federal Councilor is the head of the FDHA. It is responsible for the Swiss Agency for Therapeutic Products (SATP), public health and social insurance.
Federal Office of Public Health: It is part of the Federal Department of Home Affairs and has key responsibilities including
The final decision for pricing and reimbursement
Health system regulation
Regulates the distribution margin between wholesalers and pharmacies
Federal Drug Commission: It comprises 20 members including physicians, pharmacists, hospital, health insurer, drug industry, cantons, SATP, and insured person.
It is the body that evaluates the new therapies and reports to FOPH
Swiss Agency for Therapeutic Products (SATP): It is involved in market authorization and surveillance. It works based on the Swiss Law of Therapeutic Products.
Organization of Swiss Health Insurers: Santésuisse is the organization which comprises of all the health insurers in Switzerland.
Involved in the negotiation of prices with the pharmaceutical companies
Access to drugs in Switzerland is at two levels:
1. The drugs are approved by SATP
2. Positive reimbursement decision by FOPH and inclusion in the positive list.
After the drug approval, the company should submit the reimbursement application within 300 days to FOPH.
There are 5 levels of evaluation in Switzerland
1. Therapy Breakthrough
2. Therapy progress
3. Saving compared to other drugs
4. No therapeutic progress and no saving
5. Not appropriate for the social health insurance
FOPH makes the final decision on the recommendations. Efficacy and appropriateness are evaluated based on the SATP assessment. The cost-effectiveness is based on the values from Germany, the United Kingdom, Denmark, the Netherlands, France, and Austria. Innovation reward of 20% is usually provided during patent protection. After the FDC meeting, it takes 30 days to be included in the positive list.
It occurs every 3 years and after the patent expires.
In case if the products get a negative evaluation, the company will be informed the same. The company can again apply for the re-evaluation.
1. ISPOR: Switzerland HTA road maps available from https://tools.ispor.org/htaroadmaps/SwitzerlandPH.asp