[Swiss healthcare system: a bulimic machine]. / Système de santé suisse : une machine boulimique.

Healthcare costs are a sensitive issue in Switzerland, in particular because of the financial burden of insurance premiums on households. The amount of resources allocated and their significant and regular increase seem to be out of control. But what do these costs really represent? How do we fuel our "machine" and what is the combustion mechanism behind it? At a time when debates are often very much focused on individual interests, this article attempts to answer these questions and to examine the sustainability of a health policy that focuses above all on illness and the cost of care.

Les coûts de la santé sont un sujet sensible en Suisse, notamment du fait du poids financier des primes d'assurance qui pèse sur les ménages. Le montant des ressources allouées et leur augmentation significative et régulière semble non maîtrisable. Mais que représentent réellement ces coûts ? Comment alimente-t-on notre « machine ¼ et quelle est la mécanique de combustion qui se cache derrière ? À l'heure où les débats sont souvent très orientés autour des intérêts de chacun, cet article tente de répondre à ces questions et interroge la durabilité d'une politique de santé focalisée avant tout sur la maladie et le coût des soins.

Système de santé suisse†: aux origines de la machine.

Le système de santé suisse s'est construit au fil des 2 derniers siècles au gré de choix politiques et de l'évolution de la médecine. Mais, à l'heure où les questions de santé et de coûts sont de plus en plus souvent mises à l'agenda politique et que des défis majeurs de santé publique se présentent, il apparaît important pour la population et, en particulier, pour les professionnels de santé de se réapproprier son fonctionnement, sa construction et ses valeurs afin d'être en capacité d'en débattre avec le plus d'acuité possible. Cet article reprend, à partir d'un regard historique, les fondements du système de santé suisse et tente de préciser ce qu'il recouvre en termes de «â€…santé ¼ et de «â€…système ¼.

Influenza surveillance using data from a telemedicine centre.

OBJECTIVES: This study aimed at investigating whether data from medical teleconsultations may contribute to influenza surveillance. METHODS: International Classification of Primary Care 2nd Edition (ICPC-2) codes were used to analyse the proportion of teleconsultations due to influenza-related symptoms. Results were compared with the weekly Swiss Sentinel reports. RESULTS: When using the ICPC-2 code for fever we could reproduce the seasonal influenza peaks of the winter seasons 07/08, 08/09 and 09/10 as depicted by the Sentinel data. For the pandemic influenza 09/10, we detected a much higher first peak in summer 2009 which correlated with a potential underreporting in the Sentinel system. CONCLUSIONS: ICPC-2 data from medical teleconsultations allows influenza surveillance in real time and correlates very well with the Swiss Sentinel system.

Patient adherence to recommendations after teleconsultation: survey of patients from a telemedicine centre in Switzerland.

We investigated patients' adherence to recommendations after telephone triage at the Swiss Centre for Telemedicine. We studied cases where the medical problem was assessed as not requiring an immediate face-to-face consultation. Two weeks after teleconsultation, follow-up telephone interviews were conducted with 1129 self-care patients. The patients were asked if they had adhered to the telephone recommendations and whether they had had a subsequent face-to-face consultation. A total of 1003 patients (88%) were available for the follow-up telephone interview. Of those, 85% reported that they had adhered to all self-care recommendations and 86% had followed the advice about further use of the health-care system. Overall, 28% of patients had attended a face-to-face consultation. Half of them were referred by the teleconsultation centre, and half of them had decided themselves not to follow the centre's recommendation. Since acceptance of self-care recommendations after teleconsultation was high, teleconsultation may be an efficient alternative to face-to-face consultations for some conditions.

Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?

This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. This paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non-monetary costs but also benefit from reduced premiums.