The Swiss healthcare ecosystem is rather complex, since it combines aspects of managed competition and corporatism in a decentralised regulatory framework. The system is characterised by the allocation of decision-making or decision influencing powers to (1) the three different levels of government (the Swiss Confederation, the 26 Swiss cantons and the 2352 municipalities in Switzerland); (2) the recognised private healthcare organisations, such as Swiss Red Cross, Swiss Patient Organisation, Swiss Cancer League and the organisation of the mandatory health insurance (MHI) providers; and (3) the Swiss citizens who can veto against or demand a reform through public referenda and plebiscite.2
The Swiss Confederation (i.e., the federal state) is only permitted to act in those fields in respect of which it is granted powers to do so by the Swiss Constitution. The most important fields are (1) the funding of the health system (through the MHI and other social insurances); (2) ensuring quality and safety of medicinal products and medical devices; (3) ensuring public health (control of infectious diseases, food safety, health promotion); and (4) research and training (third-level education) of non-physician health professionals.3 The most important piece of legislation by which the Swiss Confederation steers the Swiss healthcare system is the Federal Health Insurance Act (HIA),4 which sets the legal framework of the MHI system and in particular defines which services are to be paid by such system.
The Swiss federal government, the so-called Federal Council, and the Swiss parliament enact laws and ordinances that are to be implemented by the Swiss cantons. On a governmental level, the Federal Office of Public Health (FOPH), which is part of the Federal Department of Home Affairs (FDHA), is responsible for the development of national health policies. The responsibilities of the FOPH include other tasks, such as the supervision of mandatory health insurance, decisions on the reimbursement and the prices of therapeutic products and the regulation of university-educated medical and healthcare professions. It also represents the health policy interests of Switzerland in international bodies and with regard to other states.5
The responsibility for the provision of healthcare services lies mainly with the 26 Swiss cantons. The cantons maintain and, together with the MHI, finance hospitals and nursing homes, which they also supervise. In...