Swiss Review 2/2019

Swiss Review / March 2019 / No.2 7 tors around the country is uneven. The urban canton of Basel-Stadt has 10.1 doctors per thousand inhabitants, while the mountainous canton of Uri only has 1.8. Divergent trends also come into the equation. On the one hand, there is a shortage of GPs. On the other hand, entry restrictions are de- signed to prevent toomany independ- ent doctors from practising. This par- ticularly applies to themore expensive specialists who work in urban areas. Thus, there is a danger of having at the same time a lack of doctors and a sur- plus of doctors. One thing that is clear, however, is that healthcare costs in Switzer- land are increasing year by year. Switzerland’s mandatory health in- surance premiums reflect this. Poli- cymakers have difficulty curbing the rise in costs. This is due, not least, to the complicated Swiss healthcare system that involves both state inter- vention and the free market, and fea- tures numerous stakeholders and varied interests – from the federal government, the cantons and munic- ipalities, to doctors, hospitals, health insurers and patients. Protest outside parliament Switzerland’s GPs lost patience in 2006. When the then health minister Pascal Couchepin (FDP) introduced a plan to reduce laboratory tariffs, it led to unusual scenes inBerne. Thousands of doctors took to the streets for the sake of their profession, demonstrat- ing in front of the Federal Palace. The “Yes to family medicine” popular initi- ative also helped to exert pressure. In 2014, the electorate voted very clearly in favour of a counter-proposal to this initiative. This granted constitutional status to general practice medicine, meaning that the federal government and the cantons must now ensure ad- equate provision of high-quality pri- mary healthcare and promote the GP profession as a key component in this regard. A master plan initiated by Couchepin’s successor Alain Berset (SP) gave GPs a better deal on tariff is- sues, while education and further training were also improved. Has this been the right medicine? And why were ever fewer young doc- tors deciding to become GPs in the first place?We went to Berne’s univer- sity quarter to find out. Professor Sven Streit works at the university’s Insti- tute of Primary Health Care (BIHAM), which was founded in 2009. The fact that primary care is now treated as an academic discipline is part of the solu- tion, he believes. “GPs had an image problem within the medical profes- sion.” They were regarded as practi- tioners who were far removed from the research environment. Training the GPs of tomorrow “This was completely unjustified,” he adds, pointing out that GPs have a broad range of knowledge and rely on research findings just as much as spe- cialists who work at central hospitals. Four professors now teach and carry out research at BIHAM on issues such as high blood pressure or the provi- sion of care to elderly people with multiple illnesses. BIHAMalso focuses on training the GPs of tomorrow– and its efforts are beginning to pay off. “Some 20 per cent of medical students say that they want to become GPs – twice as many as ten years ago,” says Streit. This is probably because prospec- tive doctors are now sent out during their studies to dowork experience at a general practice. As part of their spe- cialist training after graduation, they also have the chance to do an assist- antship at a GP surgery, with the can- tons subsidising a portion of their sal- aries. For example, the canton of Berne pays 1.5 million Swiss francs to 35 GP trainees each year. Streit says that 80 per cent of those who do an as- sistantship go on to become GPs. “These practical insights are impor- tant.” They lend a fresh image to the profession. No more going it alone For Streit, the attraction of working as a GP is the human side of being close to your patients and focusing holisti- cally on their needs. Not only that, but GPs also have different working con- ditions nowadays. Younger doctors no longer want to be on call seven days a week as their predecessors were, he explains. They prefermore structured working hours. Many like working An ageing population, more chronic illnesses Switzerland’s population is getting older. According to the Federal Statisti- cal Office, the number of inhabitants over 65 is likely to rise from 1.5 mil- lion to 2.7 million by 2045. The growing proportion of elderly people, not to mention the modern lifestyle characterised by smoking, an unhealthy diet and too little exercise are leading to an increase in chronic illnesses such as cancer, diabetes, cardiovascular disease and dementia. Many older people suffer from several illnesses at the same time. Chronic illnesses now account for the biggest share of Switzerland’s 80-billion-franc annual healthcare bill. (SWE) An unusual sight in 2006: GPs demon- strating in Berne. Photo: Keystone