Abstract
BackgroundAccording to the Organization for Economic Cooperation and Development, the Swiss healthcare system is one of the most effective in the world. Yet, as other occidental countries, it has to face the increase of chronic diseases frequency and its resulting cost, particularly for primary care (PC). However very few consistent data are available to describe PC features and its evolution over time. The aim of this study is to describe the evolution of the Swiss PC physicians’ (PCPs) profile and activities between 1993 and 2012.MethodsThe date come from two independent European surveys carried out in Switzerland respectively in 1993 and 2012. Both surveys were cross-sectional ones and based on representative samples of 200 PCPs, interviewed by questionnaire.ResultsIn 20 years, PCPs became older (median age 46 vs 56, p < 0.001) and more feminized (7 % vs 22 %, p < 0.001). Nowadays, they more often work in group practices (28 % vs 52 % in 2012, p < 0.001) and are more involved in other paid activities (28 % vs 66 % in 2012, p < 0.001). All the PCPs have a computer in 2012 (78 % in 1993, p < 0.001) and it is mostly used for keeping records of consultations (47 %). The number of daily face-to-face contacts with patients decreased from 31 to 24 but the average length rose from 15 to 20 min (p < 0.001). PCPs provide fewer pediatric and gynecological services but their activity remains globally unchanged in other domains. The frequency of meetings with other disciplines decreased significantly (e.g. once/month face-to-face meets with ambulatory specialists: 78 % vs 23 % in 2012, p < 0.001). The involvement of PCPs in follow-up and treatment of chronic disease globally little differed. In 2012, 8.5 % of the PCPs never performed any chirurgical acts (vs 0 % in 1993, p < 0.001).ConclusionThis study showed a substantial evolution of Swiss PC over the last twenty years in terms of socio-demographic, organizational and service provided. The main changes include: feminization and ageing, lower diversity in services provided, fewer but longer consultations. These changes may have important implications for patients’ management and will need to be considered for health planning purposes.
Highlights
According to the Organization for Economic Cooperation and Development, the Swiss healthcare system is one of the most effective in the world
Between 1993 and 2012, the proportion of women among PC physicians’ (PCPs) rose from 7 % to 22 % (p < 0.001) and the median age increased by ten years (46 years vs 56 years, p < 0.001)
General characteristics of PCP‘s activity (Table 2) In 1993, 28 % of PCPs used to work in group practice with other general practitioners and/or medical specialists while they are 52 % in 2012 (p < 0.001)
Summary
According to the Organization for Economic Cooperation and Development, the Swiss healthcare system is one of the most effective in the world. Its main assets are related to care access, high quality in both hospital and ambulatory delivered care and large coverage by compulsory health insurance This situation combined with the high economic level of the country allows Switzerland to offer. The two major changes occurred respectively in 1996 with the implementation of the Federal law on health insurance, LaMal [4], which stipulates a mandatory health insurance for all residents in Switzerland and in 2004 with the introduction of Tarmed, which standardizes medical fees throughout the country [5, 6] Another element can be added: the implementation of a moratorium about the physicians’ installation between 2002 and 2011. It was not possible for the physicians working in the ambulatory sector to open a private practice, except if the needs were proven
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