Switzerland: merits and downsides of medical dominance

The chapter analyses the challenges, obstacles and solutions for better coordination of healthcare and long-term care in Switzerland, based on interviews with major stakeholder organizations. In Switzerland, nursing long-term care is financed by health insurance. Nonetheless, coordination is difficult, because at the organizational and professional levels both systems do not effectively cooperate. One downside of health dominance is that the social aspects of care, which go beyond nursing care, are not covered by the system, but most often need to be financed and organized privately. Another obstacle for effective coordination is unclear and overlapping competencies of GPs and long-term care professionals. Since coordination costs are not covered, there is no general standard of who should take the lead and under what conditions. Informal solutions at the local or organizational level therefore prevail. In the eyes of stakeholders, a better regulatory and financial framework for coordination is needed.