Is there too much work in Switzerland? This is what some experts think. Keystone / Gaetan Bally
Every year the healthcare bill increases in the Confederation and for many people the costs of compulsory health insurance become unsustainable. What if a possible saving item was made up of unnecessary treatments? The investigation of the RSI Patti Chiari broadcast.
This content was published on 02 October 2024 – 16:55
Nicola Agostinetti and Fabio Salmina, RSI, Patti Chiari
Operating is not always the best solution. For Claudia, a handful of physiotherapy sessions were enough to regain the functionality of a shoulder that had completely blocked one morning for no apparent reason. Yet, after the first visit, the doctor was peremptory: there seemed to be no alternative to urgently going under the knife.
However, a second medical opinion requested by Claudia disavowed the first and deemed the operation completely useless. The young patient was thus able to get by with a much less invasive and risky treatment. Not only that, Claudia’s health insurance, and ultimately the community, was also able to save quite a bit of money, at least 6,000 francs for the operation alone.
Patti Chiari’s service:
17 billion in savings per year
According to a report by the Federal Financial Control Authority from a few years ago, in Switzerland it is estimated that 20 percent of the entire healthcare bill is due to useless treatments: superfluous operations, too many diagnostic tests, drugs that bring no benefit. On a global expenditure of almost 90 billion francs per year, the potential savings would be 17 billion per year. A frightening figure.
The Institute of Second Medical Opinion (ISOM) in Lugano has been promoting the right of patients to have a second medical opinion for five years. The goal, declares its founder, Christopher Jackson, is to safeguard the patient’s health. However, avoiding unnecessary treatments allows you to reduce costs and waste at the same time.
In 40 cases out of 200 treated by the Lugano institute, the second medical opinion made it possible to avoid a surgical operation by proposing alternative treatments, less invasive, less expensive and which proved to be equally effective.
Strong differences between cantons
Jennifer, for example, was operated on in Zurich for a herniated disc with an innovative and minimally invasive type of operation, thus limiting risks and long post-operative aftermath. In this case the costs of the two different operations were exactly the same, however the impact on the patient was very different. Jennifer, who had long suffered from groin pain, had previously undergone a hip arthroscopy. Only after the operation, which proved to be completely useless, was it discovered that the pain was not caused by the hip, but by the hernia.
In Switzerland, do we tend to operate too much or too quickly? Intercantonal comparisons on the number of some interventions suggest this. For example, in the Canton of Schwyz four times more menischectomy operations are carried out than in Ticino. Ten times more stents are implanted in the Canton of Uri than in Ticino. In the canton of Zug, 42 percent of births are caesarean sections, in the canton of Geneva one in four. According to the WHO, only 10-15 percent of caesarean sections are justified for medical reasons. How can these figures and differences be explained?
Refund system involved
For Nicolas Rodondi, president of “Smarter Medicine – choosing wisely”, the health insurance reimbursement system is one of the main causes that drives overmedicalization. The more expensive the service, the better the reimbursement. This is a negative incentive for healthcare providers to consume more medicine. For example, why avoid an expensive MRI for back pain if the bill is reimbursed without any ifs or buts by the health insurance company?
The “Smarter Medicine” association wants to put the patient back at the center of the healthcare system, avoiding treatments that do not bring benefits to their health. For each medical discipline it publishes a list of five treatments considered superfluous. And consequently their costs are also superfluous.
Why, asks Nicolas Rodondi for example, are so many vertebroplasty operations carried out in Switzerland? Injecting bone cement into vertebrae that have become thinner with advanced age is a controversial, expensive procedure that is not certain to benefit the patient. Yet, in our country over 2,700 were carried out in 2022 alone. Tens of millions of francs that could be saved?
Nadia also underwent a useless operation, a hip arthroscopy that shouldn’t have been done. At least that’s what she was told in an orthopedic clinic in central Switzerland: that type of operation is only done on patients under forty. Thus began an odyssey for Nadia that she could have avoided. The surgery she underwent in Ticino had complications that led her to implant a hip prosthesis at a young age. In fact, any operation involves risks, possible complications and consequently additional costs.
Are you operating too much?
Is there too much work in Switzerland, then? What is certain is that our country holds several world records in the surgical field. In hip prosthesis implantation for example: 323 per 100,000 inhabitants per year, almost double the average of OECD countries. Ditto with regards to knee prostheses, 273 per 100,000 inhabitants, in Italy less than half of them are implanted. Switzerland is also first in the world for prostatectomy, appendectomy or hysterectomy operations. Every year, 263 out of every 100,000 women have their uterus removed, almost double the rate in Sweden. How do you explain it?
According to Jackson, a surgeon tends to operate because he believes in the effectiveness of his discipline. However, the payment of many services on the spot, he adds, pushes doctors and hospitals to multiply interventions, so as to increase their economic profit.
This is what happened to Patrizia. Months after an illness that resolved in a few days, she was convinced to undergo a medical examination. The young woman enters the hospital without any symptoms, undergoes an MRI and then a cerebral angiography. During this exam something goes wrong, Patrizia ends up urgently at the “stroke unit” because she is at high risk of stroke. The patient is diagnosed with a cavernoma in the cerebellum, a benign tumor that the doctors initially want to operate on immediately. After a one-week hospital stay, however, the version changes radically: to operate or not, the choice is up to the patient. Patrizia therefore refuses and, at least apparently rightly so: five years later the cavernoma has no longer had any consequences.
Too many exams then? Too much haste to operate? What if the cure for the explosion in healthcare costs started right here, from superfluous treatments, useless operations, pharmacological treatments that bring no benefits and too many tests?
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