Introduction: Rising costs and stubborn waste
Health insurance costs are forecast to rise again in 2026, with premiums climbing about 4.4% as the system grapples with mounting care expenses. To understand where the money goes, four Swiss physicians were asked to identify practices that inflate spending without delivering meaningful patient benefits. Their assessments point to a handful of recurring patterns: redundant tests, poor treatment adherence, antibiotic overuse, and a broader culture of defensive medicine driven by fear.
Double examinations: The cost of redundancy
According to Myriam Ingle, copresident of the Vaud Association of Family Doctors, clinicians aim to balance thoroughness with efficiency. Tests are chosen carefully to be relevant, a logic that pleases insurers and protects patients with high deductibles. Yet the system often requires duplicates: when a patient is sent to a hospital or specialist, labs, imaging and other investigations are frequently repeated as if they are indispensable to complete a to‑do list.
The result is a cycle of unnecessary spending, patient inconvenience, and potential delays in care. Ingle argues that better communication among clinicians and a robust electronic patient record could curb this waste. A shared, interoperable record would help prevent redundant testing and align decisions around patient history and current needs.
Lack of adherence: A silent cost driver
Dr. Idris Guessous, head of primary care medicine at the Geneva University Hospitals (HUG) and vice‑dean at the University of Geneva, highlights non-adherence as a major drain on resources and a threat to patient outcomes. A chronic patient who sticks to treatment costs roughly a quarter to a fifth of what a patient who abandons therapy costs over time—an impact amplified by the waste associated with unused medications and unnecessary refills.
The challenge is cultural and practical: the consult often does not give enough time for patients to internalize the importance of a regimen, the stakes of incomplete treatment, and the risks of lapses. Guessous points to promising tools, such as SOFIA in Geneva, which uses robot‑prepared dose sachets, AI reminders, and a supportive chatbot to encourage timely dosing and engagement with therapy. He advocates institutionalizing such solutions and expanding pharmacist counseling, arguing that investing in the physician‑patient relationship yields better value than simply billing more visits.
Antibiotic overprescription: The cost and consequence of caution
Valérie D’Acremont, an infectious disease specialist at Unisanté and a professor at the University of Lausanne, notes that inappropriate antibiotic use is a global problem echoed in Switzerland. Clinicians sometimes request imaging, like chest X‑rays for patients with cough who do not meet criteria for pneumonia. Radiologists may detect minor incidental findings and fail to clearly communicate that these do not indicate infection, leaving clinicians with pressure to prescribe antibiotics unnecessarily.
The downstream effects are costly and risky: adverse drug reactions, microbiome disruption, and the looming threat of antimicrobial resistance. When antibiotics are prescribed unnecessarily, broader, more expensive drugs may be used later, and many areas of medicine—especially oncology and surgery—depend on effective antibiotics. Reducing overprescription is essential for both patient safety and overall costs.
The medicine of fear: An emotional driver of tests
Simon Fluri, pediatric chief in Valais and co‑president of the Valais pediatricians, describes a pervasive “medicine of fear.” Parents, guided by social media posts about rare but serious conditions, seek extensive testing to rule out frightening possibilities. For example, a perceived risk of infant epilepsy can prompt referrals to subspecialists and repeated EEG testing even when history and examination do not suggest a problem.
The pediatrician’s challenge is to reassure families with clinical judgment and simple assessments, avoiding unnecessary investigations that may provide false reassurance or, worse, delay appropriate care. Fluri stresses the importance of balancing caution with clinical reasoning and recognizing when observation and basic examination suffice.
What “low‑value care” means for Switzerland
Nicolas Rodondi, professor at the University of Bern and president of smarter medicine – Choosing Wisely Switzerland, frames the discussion in terms of low‑value care: interventions that offer little to no benefit to patients while consuming resources. While estimates vary, the OECD suggests that a portion of health spending is devoted to care with limited or no value; Swiss data from the Federal Office of Public Health also underscore this issue, even as costs remain largely reimbursed across the system.
Rodondi advocates indicators and independent scientific guidance to determine when a treatment should be reimbursed. He notes that drug approvals are tightly regulated, but indications can broaden post‑market, sometimes to benefit only a minority of patients. A national, science‑driven council could help OFSP set boundaries that align reimbursement with proven patient benefit, preserving incentives for high‑value care.
Moving toward smarter, value‑driven care
The doctors’ critiques converge on a common prescription: improve communication, advance electronic records, reward time spent on patient education and counseling, and implement evidence‑based tools that support adherence. The aim is not to deny care but to ensure that care is timely, necessary, and genuinely beneficial. Health insurers, policymakers, and clinicians must collaborate to rebalance incentives away from volume and toward value, even as premiums inevitably rise. If Switzerland can calibrate reimbursement to the outcomes that matter most to patients, health care will be both more affordable and more effective in the years ahead.
