A large proportion of physicians surveyed in Switzerland in 2019 rate healthcare here as good or very good. This is shown by the results of the Commonwealth Fund’s (CWF) annual health policy survey. Among other things, this shows a trend toward an increase in eHealth offerings.
The focus of the 2019 study was on the situation of primary care physicians and includes a chapter on the use of eHealth tools. The results of the International Health Policy Survey summarized in this article are recorded in reports of the Federal Office of Public Health (FOPH) and the Swiss Health Observatory (OBSAN) [1,2]. In addition to Switzerland, the following countries participated in the survey: Australia, Germany, France, Great Britain, Canada, New Zealand, Netherlands, Norway, Sweden, USA. The recruitment of the surveyed physicians in Switzerland (n=1095) was based on a random sample using the membership data of the professional association (FMH). For representativeness, the study data set was weighted based on sociodemographic criteria, with no gender or age standardization. In the Swiss sample, it is striking that more than half (50.4%) of the physicians are older than 55, which is the third highest proportion in an international comparison after France (59.9%) and Germany (52.5%). The related conclusion in the OBSAN report is that there is an impending shortage of primary care physicians in these countries [2].
Potential for improvement despite stable high satisfaction ratings
92.7% of respondents rated the overall performance of the healthcare system as good or very good – putting Switzerland ahead of Norway (87.1%) and Australia (78.9%) in an international comparison. Almost two-thirds of Swiss physicians (65.2%) rate the quality of medical care as largely unchanged over the period of the past three years. The majority sees potential for improvement above all in the following areas: Coordination of primary care with hospitals and psychiatric institutions, drug price reduction, investment in preventive measures. In terms of general satisfaction with its own medical work, Switzerland also ranks first in an international comparison. In terms of perceived stress levels, a trend is emerging – the proportion of stressed or very stressed physicians has increased in recent years. This is true not only for Switzerland, where more than a third (37.1%) of respondents fall into this group in 2019, but also for many other countries, although the increase over the past few years is relatively small by international standards (6.1 percentage points since the 2015 survey).
| eHealth offerings in the healthcare system eHealth is the integrated use of various information and communication technologies (ICT) to design, support and network all actors (hospitals, medical professionals, insurance companies, etc.) and processes in the healthcare system [3]. The goal is to make the coordination of the various players more efficient and to provide location-independent and timely access to patient-related health data. To this end, the “eHealth Switzerland 2.0 Strategy” was launched, through which digitization in the healthcare sector is to continue to be increasingly promoted until 2022 [4]. In addition to the introduction of the electronic patient dossier (EPD), the electronic exchange of information between the players in the healthcare system is to be established. |
The time required for administrative work in connection with insurance or billing is rated as a major problem by 60.7% of the physicians surveyed in Switzerland. This corresponds to second place behind Sweden (80.4%) and an increase of 10.4 percentage points since 2015. In Norway, only 11.1% see these administrative tasks as a major problem. The time required to compile clinical data or quality of care documents for government agencies or other organizations (e.g., health insurers) is a major problem for 42.0% of study participants in Switzerland. In an international comparison, this corresponds to second place just behind Germany (43.7%) and an increase of 8.6% compared with the 2015 study. A significant reduction over the same period was recorded in France (42.8% versus 18.3%) and the Netherlands (50.5% versus 37.0%).
Treatment of chronic diseases
With regard to general access to healthcare services, the situation seems to have improved in terms of waiting times for treatment by specialists in Switzerland. In 2019, 62.8% of respondents said their patients rarely or never have to wait long for such treatment, a 10.5% change from 2015. In the same period, the proportion of those who often or sometimes have to wait a long time for treatment after a diagnosis has decreased by 4.3%. Regarding financial barriers to health care services (including medications), 64.6% report that their patients often or sometimes struggle in this regard. With regard to chronic diseases, a survey was conducted in 2019 to determine how frequently various types of treatment are carried out: More than half (59.6%) of physicians in Switzerland use treatment plans often or most often. Monitoring of patients during consultation intervals, on the other hand, is rarely practiced. Online-based monitoring systems (e.g., Internet) are used particularly rarely (19.7%) or never (76.2%). A majority of physicians working in primary care in Switzerland are well prepared for chronic diseases and mental health problems, while patients with the need for palliative care and with dementia are more likely to challenge the respondents. In particular, many physicians perceive substance dependence problems (e.g., drugs or alcohol) as a challenge. The proportion of those who consider themselves well prepared for patients with a substance use problem is generally low in international terms. At 24.4%, Switzerland ranks third behind Germany (28.3%) and Norway (44.3%). Regarding dementia issues, 46.6% of physicians consider themselves well prepared.
Use of eHealth tools can be expanded
Increasingly, doctors working in primary care in Switzerland are documenting their patients’ medical histories electronically. In an international comparison, however, Switzerland still ranks last. Also in terms of eHealth offerings for patients or eHealth use in physician collaboration,
Switzerland has a lot of catching up to do and potential for improvement compared to other countries, according to the report by the
OBSAN [2].
Support for practice work: Nearly two-thirds (65.6%) of surveyed physicians in Switzerland use an eHealth tool to track all ordered lab tests. Only 17.6%, on the other hand, use an eHealth tool to send reminders, which is second to last in an international comparison, ahead of France (9.7%). A reminder service regarding notification of test results to patients is used by about one third (33.4%) of Swiss physicians, while a proportion of 16.4% receive a reminder for guideline-based interventions and screening.
Support for coordination with care providers outside the practice: 46.5% of respondents are able to exchange clinical pictures of their patients with specialist colleagues outside the practice. Transferring lab data or other diagnostic tests 51.6% use, while 44.1% can electronically transfer patient-specific medication lists. According to the OBSAN report [2], Switzerland has the potential to catch up in this respect in an international comparison. As a result, it finished third last twice and fourth last once. In Europe, Norway, the Netherlands and Sweden are particularly advanced in terms of electronic exchange of patient data.
Support for patients: In terms of the ability to communicate via email or secure website with their doctor’s office regarding a medical question, Switzerland (79.9%) ranks second internationally behind Sweden (91.1%). Overall, this is a service that is well established in most of the countries surveyed [2]. Online appointment scheduling (without e-mail) is possible at 10.2% of physicians in Switzerland, which corresponds to the last rank in an international comparison. In Switzerland, 11.8% of doctors offer the option of requesting a prescription renewal, and 7.5% of practices offer the option of viewing a patient file online. There are major differences with regard to the availability of an online summary of doctor’s visits: While the proportion in Switzerland is only 2.8%, this option is relatively widespread, especially in Sweden (87.5%), the USA (66.7%) and the UK (46.2%).
Literature:
- FOPH: International Public Health Survey 2019, www.bag.admin.ch/bag/de/home//publikationen/forschungsberichte/forschungsberichte-international-health-policy-survey-ihp-des-commonwealth-fund-laendervergleiche/ihp-befragungen-aerztinnen-und-aerzte-in-der-grundversorgung.html
- Pahud O: Physicians in primary care – situation in Switzerland and in international comparison. Analysis of the 2019 International Health Policy (IHP) Survey by the U.S.-based Commonwealth Fund Foundation on behalf of the Swiss Federal Office of Public Health (SFOPH). Swiss Health Observatory (OBSAN) 2019, Report 15.
- ehealth Suisse: Commonwealth Fund 2019 study: outcomes in eHealth tools, www.e-health-suisse.ch/fileadmin/user_upload/Dokumente/D/factsheet-commonwealth-studie-ehealth-schweiz.pdf
- ehealth Suisse: Strategy eHealth Switzerland, www.e-health-suisse.ch/politik-recht/strategische-grundlagen/strategie-ehealth-schweiz.html
HAUSARZT PRAXIS 2020; 15(1): 39-40
