National sections


General Practice in Switzerland


Dr Hartmut Seifert, Head of the Swiss UEMO Delegation

Switzerland has a very liberal health care system. It is a system wilh primary and secondary health care. Patients have a free choice of general practitioner, specialist and hospital outpatient can'.'l'ln'y also have a free choice of hospital. This free choice is one of the most important elements of the Swiss Health care system. Swiss general practitioners do not serve as gatekeepers to higher specialised care. The national law on social health, dating from 1919, is now subject to a major revision. The Federation of Swiss Physicians (Foederalio Medicorum Helveticorum, FMH) is still an organisation which is independent of ihe government. The FMH is responsible for the postgraduate training and continuing education for general medicine as well as for the other medical disciplines. It also has to ensure me standards and me quality of Swiss medicine. At present, a programme for permanent medical training and education is under discussion. For tile moment, there are no arrangements for re-certificalion, Since 1992, the FMH has been a full member of UEMO. It is represented by two general practitioners as delegates:

Left: Or H Seifert, Head of the Swiss UEMO Delegation

Dr med. Hartmut Seifert, President of the Swiss Association of General Practitioners (SGAM/SSMG); and Dr Willy Buss, former Vice President of the SGAM/SSMG;. The SGAM/SSMG is one of the 25 specialised medical societies associated to the Federation of Swiss Physicians. It was founded in 1977 and has since established its own bodies of undergraduate, postgraduate and continuing education. In 1966, General Medicine was recognised as a speciality by the Swiss Medical Council. However, it still has no departmental status within any of the medical faculties. The major objective of the SGAM/SSMG is to grant efficient and highly qualified primary care to the population. Together with the FMH, the SGAM/SSMG therefore established a postgraduate training programme in which the terms for qualification as a Swiss general practitioner are stipulated. The vocational training lasts at least five years and has to cover the following disciplines: two years of internal medicine and one year of general surgery. The remaining two years can be divided amongst the other specialities, mostly gynaecology and obstetrics, paediatrics, psychiatry and rheumatology. Six months of the total training can be absolved in the surgery of a general practitioner who was appointed by the SGAM/SSMG and the FMH. In addition to the vocational training, a thesis for the doctorate is finally required to obtain me title of Specialist FMH in General Medicine. The FMH and the SGAM/SSMG want to include Hie regulation of postgraduate training in (lie revised national law on social health. Until now, there has been no regulation as to the establishment in free practice of physicians. It is still possible to establish oneself as a general practitioner in free practice immediately after graduation from medical school. The admission to medical school is still free after tlie successful completion of high school. No pre-registrations or restrictions are yet enforced. It lasts six years. In 1992, there were 2,294 general practitioners in Switzerland with the above mentioned title of the FMH. 1,7% physicians in general practice have not fulfilled tlie requirements of FMH and SGAM/SSMG. Out of the 11,120 doctors established in free practice, 37 per cent are working as general practitioners. The overall density of physicians in free practice is now 14 doctors to 10,000 inhabitants or one doctor to 624 inhabitants. During the last decade, (lie number of general practitioners lias increased less notably than the number of other specialists. A major objective of the SGAM/SSMG is to increase the percentage of general practitioners to 50 per cent. The SGAM/ SGAM/SSMG is convinced.That is a good way to reduce the costs of health care.Swiss general practitioners in independent practice are free entrepreneurs.They choose the infrastructure of their surgery themselves.Most of the general practitioners have their own X-ray plant as well as a laboratory for blood analyses.They also have the means for cardiac examinations with ECG.During the last few years,a growing number of general practitioners have received training in order to make ultrasonic examinations in their surgeries.Many general practitioners also have an infrastructure to do physiotherapy.At least in the German-speaking part of Switzerland,general practitioners provide their patients with the necessary medicines out of their own pharmacy.Health expenditure in Switzerland is about SFr30 billion or eight per cent of the gross inland product.Until now health insurance has not been mandatory at the national level but it will be as soon as the revised law is enforced.The insurance will be financed by premiums paid by the insured persons.To avoid social discrimination,the new law shall provide for subsidies to the insured according to their income tax revenue.If all goes well,the revised law will be enforced in 1995.