Digitization in healthcare:
the CHF 8.2 billion opportunity for Switzerland

September 2021 | Report

From Marion Hämmerli, Thomas Müller, Stefan BiesdorfSirus RamezaniValentina SartoriMichael SteinmannLieven van der Veken, Elgar Fleisch and Florian von Wangenheim

Switzerland is known for its first-class healthcare system. However, compared to other countries, Switzerland has not yet taken equal advantage of the opportunities from digitization in healthcare. For example, in the 2018 Digital Health Index conducted by the Bertelsmann Stiftung, Switzerland ranked only 14 out of 17 for its digitization status.


International examples show that accelerating digitization could bring a vast amount of benefits for patients, consumers and other healthcare stakeholders, in terms of improved health outcomes, treatment quality, and patient experience and empowerment also in Switzerland. In addition, we estimate that the country has an enormous potential to overcome increasing expenditures and save up to CHF 8.2 billion with healthcare digitization, which is becoming increasingly important also in Switzerland, given its comparably high healthcare expenditures. 

Value pools for digitizing healthcare in Switzerland


The study focuses on the savings potential from 26 digital, healthcare-related technologies, which were categorized in 3 types: digital health solutions, those that involve patients directly; e-health, solutions primarily focused on healthcare professionals and providers; and enablers, systems that support the overall ecosystem of stakeholders and processes. We find that the total savings potential from digitizing healthcare in Switzerland across these 3 categories with currently existing technologies sums up to CHF 8.2 billion or 11.8% of the total addressable healthcare expenditures of CHF 69.7 billion.
 
The analysis also expands on how the benefits of digitizing the Swiss healthcare system come primarily from efficiency improvements, such as automated workflows and decision support at providers (67%), where they free up resources and time that can be re-invested in patient-focused activities. The remaining savings potential (33%) mainly comes from reductions or shifts in demand and benefit other actors in the healthcare value chain, primarily health insurers and other payors.
 
Exhibit 1 - Benefits of 26 digital health technologies
 
The assessment of the specific impact of each value pool was based on an evaluation of more than 500 scientific publications. This methodology has been used several times in previous publications for other countries (McKinsey, 2021: Digitalisierung im Gesundheitswesen, die 4,7 Mrd. Euro Chance für Österreich; McKinsey, 2018: Digitalisierung im Gesundheitswesen: Die Chancen für Deutschland).
 

Digital health value pools with significant improvement potential for Switzerland


To increase digitization in its healthcare system and realize the identified efficiency potential, Switzerland could learn from the best practices being implemented by more advanced countries in healthcare digitalization. Teleconsultation, chronic patient remote monitoring, chronic disease self-management, unified electronic medical record (HER), and e-prescription are the six main technologies already explored in peer countries that would have the largest value to enhance Swiss healthcare.
 
Exhibit 2 - Comparison of Switzerland’s maturity across the five most relevant digital health value pools
 
Teleconsultation
Teleconsultation could benefit many Swiss patients, as it frees up time and can increase access to doctors and specialists. For people in remote areas, that also means reaching specialists from other parts of the country. The United Kingdom and Sweden are good examples of teleconsultation adoption. In the United Kingdom, 14% of consultations before the pandemic were already conducted remotely before the pandemic, further increasing to 48% during the pandemic. In Sweden, 17% of the population generally uses digital consultations, and ~9% of all consultations were digital in 2020. In Switzerland, teleconsultations outside the stage-gate basic health insurance model have not been widely adopted, although there are some successful players for specialties like dermatology.

Chronic patient remote monitoring
There are several advantages to chronic patient monitoring that could better serve the Swiss population. The technology could improve the quality of care and outcomes. It would allow detecting early signs of deterioration in a patient's health status; simultaneously, it would enable patients to stay longer in their familiar surroundings, enjoying a more normal life. In the Netherlands, ~75% of hospitals report applying some form of remote patient monitoring for chronic diseases, e.g., intestinal diseases, and diabetes. In Canada, several provincial "telehomecare” projects have been launched successfully to encourage remote patient monitoring. In Switzerland, chronic patient remote monitoring is mainly limited to pilot and research initiatives. The pandemic has sparked additional demand for home monitoring, but to date uptake on behalf of caregivers has been slow.

Chronic disease self-management
Chronic disease self-management would allow patients to stay closer to familiar surroundings. It can also lead to improved outcomes, as it helps patients to be more compliant with medical prescriptions. As the first country in Europe, Germany has adopted a clear regulatory framework enabling physicians to prescribe and insurers to reimburse digital therapeutics, the self-managed medical interventions based on apps aiming to impact the course of a disease directly. In Switzerland the adoption of this technology is in its infancy and has not been structurally encouraged so far.

Unified electronic health record (EHR)
Unified electronic health records are advantageous because they diminish redundancies as all players have access to all relevant information. For example, Sweden and, to some extent, Italy have demonstrated successful availability and high penetration rates of an EHR. Despite initial attempts, Switzerland does not yet have a unified EHR in place across all cantons and has encountered many challenges in its implementation.

E-prescription
E-prescriptions could save much time for both health care professionals and patients and bring substantial benefits if combined with robust fraud prevention mechanisms. In Finland, the vast majority of prescriptions are now electronic, whereas in Switzerland, e-prescriptions are not been widely used. The country still misses developing a standardized architecture and format for e-prescriptions across healthcare providers.

Actions for a better and more affordable Swiss healthcare

 
Although Switzerland has a solid infrastructure to support healthcare digitization, from high coverage of broadband internet to a population with high digital literacy, that foundation has not been used at its best so far, mainly for structural reasons (e.g., federalism).
 
Nevertheless, several actions could already be taken now to increase the level of digitization in the Swiss healthcare system, with the benefits in terms of efficiency and quality that digitization can bring.
 
1. Get incentives right: introduce an appropriate cost reimbursement scheme for digital health solutions, and address cost concerns by handling reimbursement for digital services with a set of rigorous monitoring and cost-controlling measures (incl. potentially outcome-based reimbursement schemes). This can be tested by payers by reimbursing digital healthcare services within the already existing supplementary health insurance scheme (VVG).

2. Have the basics in place: accelerate the implementation of a basic digital infrastructure such as the EPD to scale up the digitization of healthcare, including solicitating input from patients and patient organizations early in the process.

3. Create clarity to foster trust: healthcare professionals and consumers must trust technology providers to hold their interest at heart and be informed on how their data is processed and stored; For that to happen, establishing clear guidance on standards for data privacy and protection is crucial. In Switzerland, those standards could be developed by industry participants as a self-regulation scheme outside government action in line with long-standing subsidiary policy-making in the country.

4. To measure is to know: promoting continuous evidence generation will stimulate innovation and adoption. Technology providers and healthcare providers should continuously collaborate to design and launch evidence-generating pilot programs for digital health solutions, which will increase trust and encourage use by the medical doctors community.

5. Don’t wait: despite the regulatory and reimbursement environment not being optimal, there are many opportunities for players in the Swiss healthcare system to make a difference today. There is a chance to start by investing in partnerships that can make a difference now through win-win-win dynamics, that benefit patients, providers and payors. Successful use cases will set examples and create a positive dynamic, which will eventually accelerate digitization in the Swiss healthcare system.


  

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