Overview and positions on selected healthcare reforms

Cost containment packages 

Parliament has been discussing various measures to contain costs in the healthcare system for some time. These proposals are based on a report by a group of experts on cost containment measures to reduce the burden on compulsory health insurance (OKP). An initial cost containment package was divided into two sub-packages (KP 1a and 1b) during the parliamentary deliberations.  

The debate on sub-package 1a was concluded by the Councils in the 2021 summer session. The industry took note of the fact that, in contrast to the Federal Council, both chambers did not envisage a mandatory obligation as part of the experimental article. 

After lengthy deliberations, the Federal Assembly then adopted CP 1b in the 2022 autumn session. This provides for cost monitoring in the healthcare system. Fortunately, the Councils cancelled the reference price system for generics, but simplifications were agreed for the authorisation of parallel-imported medicines.  

In August 2020, the consultation on a second package of measures (KP 2) was then opened and scienceindustries submitted its position paper. Parallel to this package, the proposed introduction of targets in the healthcare system in the form of Federal Council counter-proposals to the cost brake initiative of the centre and the premium relief initiative of the Social Democratic Party (SP) were sent for parliamentary consultation. 

The National Council (NR) discussed KP 2 in the 2023 autumn session and spoke out in favour of confidential pricing models for medicines that qualify for accelerated approval by Swissmedic. In future, the Federal Office of Public Health (FOPH) should also be given the option of exempting medicines with low sales or that are critical to supply from the periodic price review.  

Health initiatives 

This year will see referendums on two popular initiatives in the healthcare sector. The centre-right initiative "For lower premiums - cost brake in the healthcare system" demands that the Federal Council, parliament and cantons must intervene as soon as the annual average increase in OKP costs per insured person exceeds the development of an indicator not defined more precisely by the initiators (nominal wages, price index, etc.).  

The Social Democratic Party's (SP) premium relief initiative demands that no household in Switzerland should have to spend more than 10 per cent of its disposable income on health insurance premiums. At least two thirds of the necessary premium reductions should be financed by the federal government and one third by the cantons. scienceindustries rejects both initiatives: The cost brake will inevitably lead to rationing in access to innovative therapy and jeopardise the security of supply of proven therapies.  

Instead of a rigid rationing system, false incentives in the financing of basic insurance should be eliminated (e.g. promote outpatient services wherever possible). Reducing the burden on premiums would create a considerable disincentive, as it would reduce personal responsibility for the use of services.  

As a result, it would only lead to higher healthcare costs and less transparency about who pays for them. The benefits in the OKP are covered by capitation premiums, deductibles and co-payments on the one hand and by tax revenue or premium reductions on the other, which means that solidarity and personal responsibility are already practised today. Parliament has also adopted two indirect counter-proposals to both initiatives, which partially implement the concerns.  

Catching up on digitalisation 

Digitalisation offers a range of promising opportunities in the healthcare sector in particular, including in the availability of healthcare data and in research and development, but Switzerland in particular has a lot of catching up to do in this area. The topic of digital transformation in the healthcare sector is highly topical, even though the Federal Council included a chapter on "Health and healthcare" in its strategy for an information society back in 2006, focussing on the use of ICT information and communication technologies in the healthcare sector ("eHealth"). scienceindustries has always supported these goals and continues to work towards achieving them. 

Electronic patient dossier as a key dossier 

A central aspect of the Federal Council's strategy was the introduction of the electronic patient dossier (EPD). The basic idea behind the EPR is that data can be recorded and exchanged electronically according to a standardised structure. In order to increase the benefits for all potential users, the Federal Council wants to revise the Federal Act on the Electronic Patient Record.  

scienceindustries is in favour of an accelerated approach to digitalisation in the healthcare sector. Insofar as this goal can be achieved with the EPR, it welcomes the further development of the EPR in principle. However, progress must be faster and, above all, coordinated. Furthermore, scienceindustries is in favour of making participation in the EPR a prerequisite for the authorisation of service providers. Further steps must follow, in particular technology-open interoperability of the system, a simple and user-friendly design and the promotion of general acceptance of digitalisation in the healthcare sector in general and of the EPR in particular among the population. 

DigiSanté: promoting digital transformation in the healthcare sector 

DigiSanté is the FDHA's programme to promote digital transformation in the healthcare sector. It is being developed on behalf of the Federal Council and will be formulated by the FOPH and the FSO in an initialisation phase until the end of 2024 and should then be implemented by the end of 2034. The Social Affairs Committee of the National Council (SGK-N) has spoken out in favour of the comprehensive DigiSanté programme and the necessary commitment credit of almost CHF 400 million. The large-scale programme aims to improve the quality of treatment, the efficiency and transparency of the healthcare system and patient safety over a period of ten years. scienceindustries is committed to the digitalisation of the Swiss healthcare system and is involved in the DigiSanté working group as part of the "Digital Transformation in Healthcare" alliance. 

Security of supply 

Drug shortages have increased worldwide, and Switzerland is no exception. In 2022, the Therapeutic Products Reporting Centre at the Federal Office for National Economic Supply (FONES) received around 200 reports of supply disruptions: a total of around 1,000 medicines were temporarily unavailable. The reasons for this are manifold and scienceindustries, together with other pharmaceutical associations, has positioned itself on the problem. The FOPH has reduced many prices in recent years to such an extent that the daily dose of individual products still costs a few centimes based on the ex-factory price and in some cases has fallen below the manufacturing costs. It is therefore increasingly no longer worth keeping certain products on the cost-intensive Swiss market.  

The ongoing expansion of the obligation to report shortages of medicinal products has so far brought no relief, but only additional costs for the industry. If this path is to be continued, the ongoing expansion of the reporting obligation must be accompanied by an automated reporting system financed by the federal government. The costs for the compulsory stocks - which are currently borne entirely by the pharmaceutical industry alone, without it being able to adjust prices - must therefore also be adjusted in line with other product categories and the federal government should contribute to the costs here.  

And even if there are still hardly any supply bottlenecks for authorised innovative medicines, access to new therapies has been delayed for some time. This development is increasingly jeopardising the timely provision of innovations to Swiss patients, which is not alleviating the general pressure on healthcare. Attractive reimbursement rules would promote early access to innovative medicinal products, although a one-sided price focus in healthcare policy is worsening care.

One possible solution for faster access is reimbursed innovation access (RIZ), which is currently being discussed in Parliament. Parallel or at least better coordinated procedures for authorisation by Swissmedic and the FOPH through the "early access" process would then save time. An early dialogue between pharmaceutical companies, Swissmedic and the FOPH would lead to greater parallelisation of the processes.