Health technology assessment in Switzerland

Switzerland has a mixed public and private healthcare system. All citizens are enrolled in compulsory basic health insurance. A 1996 law allows people to choose among different sickness funds and managed care plans. The feder al government is empowered to act on important health issues, but the 26 ca ntons have prime responsibility in health care and social welfare. They hav e their own laws on health care, hygiene, hospitals, and social welfare. Th ese laws are not harmonized. The system is complex, with a mix of public (m ainly hospitals) and private (mainly doctors' offices) providers. The healt h services are decentralized. Ambulatory care was traditionally provided in doctors' offices, but the last decade has seen the development of centers for day surgery, group practices, and managed care plans. Decisions on plac ement, location, and extension of services are decentralized. The payment s ystem is very complex. Current trends include global budgets, cost analyses , and prices related to patient categories. However, coverage policy is dev eloped centrally and includes both traditionally established services and n ew technologies. New technologies are added to the list only after evaluati on by the Federal Coverage Committee. The coverage process integrates healt h technology assessment (HTA). Coverage can be granted in stages, including limited coverage and temporary coverage. Technologies and coverage can be reevaluated on the basis of registries or assessment information. The struc ture of the Swiss healthcare system does not lend itself to the establishme nt of a national HTA program. However, recent moves include the development of a coordinating mechanism for HTA in Switzerland.