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Review
. 2020 Jun;124(6):605-614.
doi: 10.1016/j.healthpol.2020.05.007. Epub 2020 May 16.

Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad

Thomas Braendle  1 , Carsten Colombier  2
Affiliations
Review

Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad

Thomas Braendle et al. Health Policy. 2020 Jun.

Abstract

Growing healthcare expenditure is a major concern for policy makers and calls for effective cost containment measures. For the decentralized Swiss healthcare system, ranking second among OECD countries in healthcare spending, a group of experts has proposed budgetary targets as key measure. In order to substantiate this proposal, we review the literature and analyse experiences with budgetary targets in comparable social health insurance systems, such as Germany and the Netherlands. Budgetary targets raise the cost responsibility and prompt providers to give greater weight to cost-benefit considerations. Our analysis suggests that the involvement of all principal healthcare players and clear decision-making and negotiating structures are key to successful implementation. Risks of rationing, lower quality incentives or conservation of structures have to be countered with taking into account age-related morbidity and medical progress when setting the budgetary targets. Accompanying measures such as incentive-compatible remuneration schemes and quality monitoring are of paramount importance.

Keywords: Budgetary target; Comparative health systems; Cost containment; Cost growth; Global budget; Mandatory health insurance.

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Figures

Fig. 1
Fig. 1
Healthcare expenditure for selected countries (as % of GDP).
Fig. 2
Fig. 2
Development of average MHI premium, healthcare expenditure (HCE) per capita, GDP per inhabitant & wage index in Switzerland, 2000–2018.
Fig. 3
Fig. 3
Development of compulsory health insurance expenditure per payer, and of GDP per inhabitant in CH, GER and NL, and German basic wages from 2010 to 2016 in nominal terms (index 2010 = 100).
See this image and copyright information in PMC

References

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