- Population 7.8 million; expenditure on health is 10.8% of the GDP
Expenditure on health in Switzerland in 2007
|Costs of the health care system|| 10.8% of gross domestic product (GDP)|
| Health costs per inhabitant|| EUR 5’530|
| Costs of the health care system|| EUR 42’159 million|
| - therefrom outpatient care|| EUR 13‘261 million|
| - therefrom inpatient care|| EUR 19‘179 million|
| - others|| EUR 9‘719 million|
| Portion of (compulsory) social basic insurance|| 35% of health care expenditure|
| || |
| Expenditure on Psychiatry & Psychotherapy* (inpatient care)|
(Only psychiatric hospitals and psychiatric clinics. Psychiatric and psychotherapeutic treatments in general hospitals not included!)
| EUR 1‘412 million|
| Expenditure on Psychiatry & Psychotherapy* (outpatient care)|
Of that, expenditure on physician-delegated psychotherapy conducted by psychologists
| EUR 384.75 million (0.91% of health care expenditure)|
EUR 87.6 million (0.21% of health care expenditure)
| Costs in EUR of outpatient and inpatient psychotherapy|| No breakdown statistics available|
*In Switzerland, physicians (medical doctors) specialising in Psychiatry & Psychotherapy, as the double title indicates, work in both psychiatry and psychotherapy. There is no breakdown of the costs available for psychotherapy alone.
Psychotherapy in the health care system
- Types of psychotherapeutic treatments available
- Indication: Preconditions (e.g. prior authorisation, prior treatments)
- Quality management requirements (guidelines, outcome evaluation)
- The psychotherapeutic treatment of mental illnesses is in principle not limited to certain methods or tied to certain techniques. The 3-4 main approaches are: behavioural therapy, analytic psychotherapy, systemic psychotherapy, person-centred therapy. In Switzerland, many variants of these approaches have become established.
- With the soon-to-be-adopted Psychologieberufegesetz [Law on Professions in Psychology] and the obligatory federal accreditation of psychotherapy training programs, the main psychotherapeutic approaches are likely to gain in importance. For diagnosis the ICD-10 is usually used.
- Patients’ access (e.g. direct access, access via a general practitioner or specialists)
- Outpatient therapies and treatments by physicians (medical doctors) specialising in Psychiatry & Psychotherapy are financed by the social health insurance (up to 40 hours per year). In medical care, the services are not broken down separately for psychiatric and psychotherapeutic services.
- Psychotherapy conducted by psychologists is paid for by the social health insurance only if the psychologist is employed by a physician and the physician bears formal responsibility for the therapy. In the outpatient area, a breakdown of costs is available only for this “physician-delegated psychotherapy conducted by psychologists”.
- Primary care physicians usually refer patients with psychological problems to a medical specialist, a psychologist conducting physician-delegated psychotherapy, or a psychologist in independent practice providing psychotherapy. In the last case, however, the social insurance does not pay for the therapy, and patients only receive a partial reimbursement if they have private additional insurance.
- Referrals for inpatient treatment are usually made by medical specialists in Psychiatry & Psychotherapy but are also made by psychological psychotherapists in cooperation with medical doctors.
- Professions, qualifications prior to specialisation and postgraduate training in psychotherapy, accepted psychotherapeutic schools/approaches
- Requirements for providing services within the health care system
- Additional services (prescriptions, assignments)
- The independent conduct of psychotherapy is regulated by law in 25 of the 26 cantons of Switzerland. As a rule, psychotherapists study psychology or medicine as undergraduates; they then complete postgraduate training in psychotherapy (minimum 4-5 years). Already in 2001, 85% of psychotherapists that were not medical doctors had undergraduate degrees in psychology. At present, a federal law on professions in psychology is before the Swiss parliament: By this future national law, only psychologists or medical doctors can be trained and licensed in psychotherapy.
Psychotherapy for Depression
- Special concepts (apart from 3.)
- Best practice models
- Because depression has reached epidemic proportions, up to now eight cantons of Switzerland have launched a cantonal “Alliance Against Depression” (like the Nuremberg Alliance Against Depression). Four cantons are following a longer-term strategy in the area of mental health. As a coordinator, the federal government supports the cantons in establishing the Alliance Against Depression. However, the federal government itself has no authority to act in the area of mental illnesses. A new law on this is currently under parliamentary consultation (“federal law on health prevention and promotion”).
Desirable Changes to Health Policy
- If you were responsible for health policy in your country, what would your first decision be regarding psychotherapeutic care?
- 1. There should be a lower threshold for psychotherapy service provision, and at the same time mental illnesses (and thus also psychiatry and psychotherapy) must become destigmatised.
- 2. Access to psychotherapy should be improved, by better integrating psychologist psychotherapists into the social basic insurance.
- 3. Promotion of mental health must be improved altogether, and that includes prevention of mental illnesses.
Daniel Habegger, Federation of Swiss Psychologists FSP www.psychologie.ch
The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".
You can download the paper here.