The Swiss health care system may not be the envy of the world for much longer–or at least not in the Saanenland. The two opposing sides of the argument are nowhere near reaching a consensus. Many say the closing and consolidation of hospitals across the nation in the name of both practical and fiscal efficiency is compromising availability and quality of health care in our region.
But is downsizing truly adversely affecting medical care in the Saanenland? Will locals mourn the refusal of the Medi-Zentrum project or join with Saanen in suporting a Localmed outpatient clinic? Will they be forced to drive to Zweisimmen Hospital or even further afield?
Too Many Hospitals, Too Few Patients
Historically, Switzerland boasted a very high rate of care centres and hospitals
in relation to population. In many sparsely populated resort areas like the Saanenland and Interlaken, for example, the doors of local hospitals remained open for years despite an increasingly slower trickle of patients.
The problem was acknowledged at the highest governmental level possible, by Pascal Couchepin, former health minister, as well as many others including Christoffel Brändli, outgoing president of Santésuisse, one of two organisations that closely monitor health care in Switzerland. In 2009, Couchepin told Bilan magazine that one third of Swiss hospitals should be closed and those remaining should specialise.
Saanen official Armando Chissalé agreed last year, stating in an interview to the Anzeiger von Saanen that “The hospital was not financially viable, and patient numbers had already started to dwindle.”
Under the former system, even small, regional hospitals such as Saanen provided nearly all services. This meant that specialised operations were carried out on premises. This concerns some doctors, who feel that hospitals should have a minimum number of certain procedures performed in order to continue performing them, especially those that are risky.
Going, Going, Gone
According to the Swiss Federal Statistical Office, 44% of health care costs in Switzerland are hospital-related. By closing some regional hospitals and having others specialise rather than generalise, these costs may decrease. Since restructuring began a
decade ago, nearly 18% of hospitals have closed, bringing the countrywide total from 363 to 298.
The plight of closing local hospitals has its roots in earlier political decisions. More than a decade ago, Canton Bern created several companies to manage the restructuring of the hospital system in an attempt to cut costs. One of these companies is Spital STS AG, which manages hospitals in both Zweisimmen and Thun.
When the decision was made that one of the financially unviable regional hospitals had to be closed, Saanen Hospital drew the short straw. The facility, which had been in use for over a hundred years, closed its doors in November 2012. Since that time, local residents have had no choice but to make the 20-minute drive to the hospital in Zweisimmen, which was spared closure. Yet services in Zweisimmen continue to decrease; the hospital recently closed its obstetrics department, leaving pregnant women to make the hour and a half journey to the nearest maternity ward in Thun.
The hospital situation remains a highly controversial, emotionally charged issue. At a “sounding board” held by Spital STS AG last year, several politicians even walked out. They claimed the companies had not properly taken into account regional votes in their decision-making process.
Who Will Treat Patients?
Attempts to create a practice on the former Saanen Hospital site, known as the Medi-Zentrum, had been underway for several years. The idea was to found a medical clinic that would have been staffed by several local doctors with varying specialties. This practice would not have provided emergency care, however, but simply have gathered individual practitioners under one common roof. The region’s doctors are all subject to a 48-hour on-call period once a month, which would not have changed with the opening of the Medi-Zentrum.
Can Saanen Have its Cake and Eat it too?
Plans for the centre, called Medi-Zentrum, were presented to Saanen in late December 2014. They called for a demolition of the old hospital building and the construction of a new three-storey structure at a cost of CHF 11.8 million.
Financing was expected to be secured at an extraordinary council meeting in March 2015, but in an unexpected move, the Saanen City Council rejected the plans a month beforehand. After years of work, the project, which included the Spitexverein (local home health care provider) and physiotherapy practice along with the individual doctors’ practices, was refused in its current state.
With this “surprising and last-minute” rejection, many local doctors feel betrayed. These sentiments were explained in a press release from Drs Claudia Hauswirth, Claudia Sollberger, Nick Hoyer, Beat Michel, and physiotherapist Monika Iseli-Trachsel.
In an interview with the Anzeiger von Saanen, Aldo Kropf, president of Saanen’s City Council, claimed these were not valid concerns. Kropf insisted that the deal falling through hitched on a missing memorandum of understanding regarding the annual rental fees of the proposed building. As the owner, the municipality had calculated rent from all parties occupying the
Medi-Zentrum to amount to CHF 330000. However, the municipality would only invoice CHF 167000 (a
method of subsidation) and also foot the heating cost of CHF 45000.
That left a substantial amount for the Medi-Zentrum occupants to pay, an amount which the city of Saanen would have liked to confirm via a memorandum of understanding.
The Medi-Zentrum however could not sign such a memorandum because of a last minute issue concerning occupancy. Due to the limited space available, the Medi-Zentrum could not honour the application of a doctor practicing Chinese medecine who needed several rooms only part-time. This doctor had also declined to participate in the emergency service as the other doctors do, so the Medi-Zentrum felt obliged to refuse her application. This unfortunately left a gap of CHF 16000 in the budget allocated for rent.
Doctors maintain that the memorandum of understanding was ready to be signed and suggest the deal fell through because of this CHF 16000 discrepancy in the rental budget due to the withdrawal of a potantial tenant; a pittance for a CHF 12 million total project.
Kropf doesn't see the issue so simply.
“Such a document was necessary for this sort of project,” explained Kropf, “this is proof that we are talking about much more than just CHF 16000. We also concluded that the financial burden on our budget, after deducting the rental income, was too heavy.”
Choosing the Right Project
Saanen’s decision allowed it to remain open to investigating other solutions. A cooperation is now underway with the private company called Localmed, partially owned by the university hospital Inselspital in Bern, which runs an HMO-style clinic. Local doctors are worried patients will not be referred to them for further treatment. Others are concerned that to keep costs down, Localmed would be staffed with doctors imported from other areas, and who have no personal relationship with the Saanenland and, contrary to some local doctors, make no home visits to disabled patients. They are also worried that the hospital in Zweisimmen would be left out if Localmed refers patients only for treatment at clinics or hospitals that are partner organisations (thus the free choice of hospital would be eliminated).
Kropf agrees that supporting Zweisimmen Hospital is key. “We don't want to jeopardise the hospital,” he says, “Localmed management states that they are open to collaborating with both the hospital (ed: which is run by STS Spital AG) and local doctors.
“Our goal is good health care for the region,” emphasizes Kropf. “We are ready to talk and open to an adequate solution."
Is a Hospital Really Needed?
As a resort area, the Saanenland’s population triples from 10,000 to nearly 30,000 in the winter season. These visitors, especially the elderly population and long-term guests who spend time in second homes, worry about medical care in the case of an emergency.
“How can a ski resort area, which thrives on tourism, not have emergency care,” asks Gerald Putney, who spends approximately a third of the year in Gstaad.
Other guests, especially those based in Rougemont (a large percentage of whom are from the Geneva area) are happy to make the drive to the hospital in Château-d’Oex, where they can avoid the language barrier and converse in French.
Different Strokes for Different Folks
Doctors worry about several issues for health care in the region, one of which is an aging population. Elderly residents are also concerned that if a heart attack or stroke occurs, precious time will be wasted commuting to a distant hospitals.
“The workload of primary care physicians is increasing,“ explains Dr Hoyer. “On one hand this is due to the hospital closure in Saanen; on the other hand it’s due to demographic development.”
When the topic of an outpatient clinic is brought up, the population is again
divided. Many occasional guests or
weekend visitors say an outpatient clinic is the perfect solution for their needs. The doctors behind the Medi-Zentrum project however, believe their goal of continuing primary care and family medicine is incompatible with an outpatient clinic. Yet, this type of clinic is exactly what tourists say they’d like in the region.
“I don’t understand why this issue is so problematic,” says one frequent 56-year old guest, who chose to remain anonymous. “For locals, there are primary care physicians in the Saanenland for regular visits. There is a chance now to have an outpatient clinic with Localmed yet the area’s doctors are against it. We’ll wind up with nothing!”
Past, Present, Future
For many years there was both a selection of primary care physicians and a local hospital in the Saanenland. In operation for more than 100 years, Saanen Hospital served not only as an institution which provided necessary medical care without leaving the community, but also had a calming effect on the local population.
With the future of medical care in the Saanenland in the hands of Localmed, there is still some uncertainty about whether residents will really have the proper long-term primary care needed. The irony is that, as Switzerland dismantles its innovative health care system, the rest of the world is busy trying to build similar systems. Something to think about while you wait to be seen by a doctor in a hospital miles away from home.
The Swiss Single-Payer System--Still the Envy of the World?
The Swiss health care system is renowned worldwide for its excellent care and availability. It was even used as the model for the state of Massachusetts, the first US state to implement a single-payer type health care system. This standard of care does not come cheap, however, with premiums taking a sizeable percentage of personal income.
Basic health insurance is compulsory in Switzerland, and all residents must be covered. Single-payer refers to the fact that every person is responsible for
taking out his own insurance policy with no link to his employer, unlike in the US.
Unlike the UK’s National Health Service (NHS), Swiss insurance relies on private companies and is not a federal program funded with taxes. In addition to basic coverage, which is available to all Swiss residents with no exclusion for pre-existing conditions, customers may opt for an additional complimentary policy, which can cover a variety of extra costs such as medical devices, fitness centres, prosthetics, and more.