Rising costs frame the conversation
With health insurance premiums in Switzerland projected to rise by about 4.4% next year, the pressure on households and the health system is mounting. Four doctors closely observing the Swiss health system identify practices they consider costly but unnecessary, arguing that smarter, patient-centered care could curb waste without compromising outcomes.
Double exams: a costly redundancy
Dr. Myriam Ingle, co-president of the Vaudoise Association of Family Doctors, explains that clinicians often face a tension between efficiency and thoroughness. “As treating physicians, we know our patients and try to be as efficient as possible,” she says. “This benefits high-deductible patients and keeps care relevant.” Yet when patients are referred to hospitals or specialists, labs, blood tests, or imaging are sometimes repeated “as if they were on an indispensable to-do list.” The result is avoidable duplication that inflates costs and risks unnecessary exposure for patients. Ingle argues that better communication between doctors and a robust electronic patient record could help trim such redundancies and boost overall system efficiency.
Non-adherence: paying for medication that isn’t used
Dr. Idris Guessous, head of the Primary Care Medicine Service at HUG and vice-dean of the University of Geneva Faculty of Medicine, highlights another costly issue: patients who do not fully adhere to treatments. “Non-adherence compromises quality and costs billions,” he notes. Chronic patients who stay on medication typically incur far lower costs than those who abandon treatment. In addition to wasted drugs, Guessous draws attention to wasteful spending tied to medications that are not taken as prescribed, with environmental and resource losses creeping in as unused medicines accumulate. He points to the need to shift the consultative dynamic—giving time to reinforce patient understanding and the value of the treatment—and to institutionalize support tools that improve adherence. He cites innovative projects like the SOFIA program in Geneva, which combines robot-dispensed personalized dose bags, AI reminders, and a motivational chatbot to help patients take meds at the right times. He argues for scaled, sustainable adoption of such solutions and better time for counseling to prevent costly non-adherence.
Overprescription of antibiotics: a costly, risky habit
Valérie D’Acremont, an infectious disease expert at Unisanté and a professor at the University of Lausanne, notes that antibiotic overuse remains a global and national problem. In some cases, clinicians order chest X‑rays for patients with coughs that don’t meet pneumonia criteria, or radiology reports reveal minor, ambiguous findings that are not consistent with infection. The consequence is a cycle of unnecessary antibiotic prescriptions, contributing to adverse effects, resistance, and higher costs. D’Acremont emphasizes that many of these prescriptions are avoidable when guidelines are strictly followed and diagnostic uncertainty is managed through clinical judgment and observation rather than reflex antibiotics. The broader risk is that therapy may become broader and pricier as resistance rises, complicating future care in oncology and surgery that rely on effective antibiotics.
The medicine of fear: chasing certainty at a cost
Dr. Simon Fluri, pediatric chief at Hôpital du Valais, describes the “medicine of fear” that leads to excessive testing when parents view online information as a substitute for medical reassurance. “Parents are influenced by posts about rare but alarming conditions,” he says. As a result, some clinicians order specialist consultations or even advanced tests—such as electroencephalograms—when an adequate history and clinical examination would suffice. While investigations are sometimes necessary, Fluri argues that a reliance on excessive testing can create a false sense of security and divert resources from more meaningful, individualized care. The challenge is to reassure families while maintaining rigorous clinical scrutiny and avoiding unnecessary procedures.
Smarter medicine and Choosing Wisely Switzerland
Professor Nicolas Rodondi of the University of Bern, president of the smarter medicine – Choosing Wisely Switzerland initiative, frames the conversation beyond anecdote. He notes that estimates vary: the OECD suggests up to 20% of health spending is waste, but the Swiss Office fédéral de la Santé publique (OFSP) pins it at around 15% for the Swiss system. He stresses that “care is not simply a matter of volume; some interventions are low-value or costly with little patient benefit.” The four doctors’ examples illustrate the broader problem of high-cost, low-value care. Rodondi and colleagues advocate for measurable indicators, independent scientific guidance, and a more selective reimbursement framework. They call for a Swiss council that would advise the federal health office on which treatments are reimbursed based on demonstrable patient benefit, not broad indications that expand over time. A pilot at CHUV aims to quantify such indicators across university hospitals, while a shift toward value-based care could reduce waste without compromising essentials.
What lies ahead: turning insight into action
Many of the proposed reforms hinge on better data, transparent decision-making, and dedicated time for patient education and shared decision-making. A more accountable system would reward clinicians for effective counseling, adherence support, and the judicious use of tests and medications. If Switzerland can align reimbursement with demonstrable patient benefit and invest in supportive technologies like SOFIA, it may curb the rising costs while preserving high-quality care for all.
