The status quo: rising premiums—increasing shortage of health workforce

As recent contributions in the media show: the Swiss population is confronted with rising premiums for health insurance and an escalating shortage of health workforce. Investing more money into the health care system cannot be an effective or efficient solution as already around 25% of the Swiss population need subsidies to be able to afford health insurance. Importing workforce from abroad can neither be the right way to fill the gaps while the coming cohorts of students are smaller and interest in nursing is not increasing. In a recent interview, Daniel Scheidegger, past president of the Swiss Academy of Medical Sciences, pointed out: “Bei der Gesundheit finden heute immer noch alle: Wenn es mehr kostet, kostet es halt mehr – es geht ja um den Menschen. Aber ein grosser Teil des Geldes fürs Gesundheitswesen wird ja eben nicht dafür eingesetzt, um Menschen gesund zu machen. Gewisse Politikerinnen und Politiker sagen dann, man solle nicht nur über die Kosten, sondern auch über den Ertrag sprechen. Schliesslich arbeite jede sechste Person im Gesundheitswesen. Das Argument führt aber nirgends hin. Natürlich können wir das Ganze immer grösser aufblasen. Probleme wie Personalmangel in der Pflege und der Grundversorgung bei gleichzeitigem Spezialistenüberangebot haben wir damit aber nicht gelöst.» (Translation of the author: "When it comes to health, everyone still thinks: if it costs more, it costs more - after all, it's about people. But a large part of the money spent on health care is not used to make people healthy. Some politicians then say that we should not only talk about the costs, but also about the returns. After all, every sixth person works in the health sector. But that argument leads nowhere. Of course, we can always blow the whole thing up bigger. But we have not solved problems such as a lack of staff in nursing and primary care with a simultaneous oversupply of specialists.”) (Interview zu überlasteten Spitälern: «Wir müssen weniger Medizin machen» | Tages-Anzeiger (tagesanzeiger.ch)

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So, what? What shall we do?

The Swiss Competence Network Health Workforce (CNHW) is the unification of forces to come up with solutions to the problem of workforce shortage. Researchers from all public Swiss Universities of Applied Sciences with programs for health professions come together focusing on questions how to educate health workforce, how to make working in the healthcare attractive, and how to keep workforce in the field. Science and practice must provide evidence how to organize healthcare effectively and efficiently.

The problem of the shortage of health professionals can only be solved from within Switzerland and must rely on three main strategies:

• Make the work environment attractive so that health professionals feel that they can adequately care for patients and their families/ relatives.

• Attract those who already left health care by providing a welcoming work environment, e.g., piloting new models of working shifts, providing onsite childcare 24/7.

• Define career paths especially for the non-physician health workforce in order to develop advanced practice and to provide career perspectives for young staff.

• Cooperate and support informal caregivers to built up resources for care at home

 

Furthermore, we need to widen our view and, in response to Daniel Scheidegger’s ideas for the Swiss health care system, we need to decide wisely: What therapies and interventions should not be offered any longer when they are proven to not be effective (Interview zu überlasteten Spitälern: «Wir müssen weniger Medizin machen» | Tages-Anzeiger (tagesanzeiger.ch).

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CNHW: the next steps

Following four years of funding through project-related contributions, CNHW will now continue as an association under the umbrella of the Specialised Health Conference of Swiss Universities of Applied Sciences (CSS) and allow the positive experiences of the long-lasting cooperation, beyond language regions and universities, to continue to benefit the analysis of and measures against the shortage of skilled workers. As a direct result of this cooperation, the increased exchange between practice and research has led to initiatives that have been directly put into practice. With representatives from professional associations in the support group, the needs from practice could be picked up and ideas for further initiatives in the future developed jointly and inter-professionally.

Something we all hope is that CNHW will grow into a large and influential network that contributes to good working conditions for the health professions in the transformation process of the health system and thus will ultimately contribute to good healthcare for everyone, and that the research findings that the network has developed and is developing will have an effect on the frameworks and legislation relevant to healthcare, to the same extent that politics requires scientific bases for decision making.

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Andreas Gerber-Grote
Presidents of CNHW