Switzerland has a mixed public and private healthcare system. All citizens are enrolled in compulsory
basic health insurance. A 1996 law allows people to choose among different sickness funds and managed
care plans. The federal government is empowered to act on important health issues, but the 26 cantons
have prime responsibility in health care and social welfare. They have their own laws on health care,
hygiene, hospitals, and social welfare. These laws are not harmonized. The system is complex, with a mix
of public (mainly hospitals) and private (mainly doctors' offices) providers. The health services are
decentralized. Ambulatory care was traditionally provided in doctors' offices, but the last decade has seen
the development of centers for day surgery, group practices, and managed care plans. Decisions on
placement, location, and extension of services are decentralized. The payment system is very complex.
Current trends include global budgets, cost analyses, and prices related to patient categories. However,
coverage policy is developed centrally and includes both traditionally established services and new
technologies. New technologies are added to the list only after evaluation by the Federal Coverage
Committee. The coverage process integrates health technology assessment (HTA). Coverage can be
granted in stages, including limited coverage and temporary coverage. Technologies and coverage can be
reevaluated on the basis of registries or assessment information. The structure of the Swiss healthcare
system does not lend itself to the establishment of a national HTA program. However, recent moves
include the development of a coordinating mechanism for HTA in Switzerland.
P155 Lessons Learned: Applying Grade Methodology To Evidence-Based Health Technology Assessment Within A Managed Care Setting
