Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 150 No. 1920 (2020)

The ecology of medical care in Switzerland: prevalence of illness in the community and healthcare utilisation in Switzerland

  • Stéphanie Giezendanner
  • Wiebke Bretschneider
  • Roland Fischer
  • Laura Diaz Hernandez
  • Andreas Zeller
Cite this as:
Swiss Med Wkly. 2020;150:w20221



The allocation and equal distribution of healthcare resources is one of the major challenges of today. Therefore, a framework to analyse the prevalence of illness in the community and the use of various sources of healthcare is crucial. The aim of the study was to evaluate the health-seeking behaviour of 1025 individuals in Switzerland in a 2-month period in 2018.


Population-based, cross-sectional health survey with a multistage, stratified cluster design. The LINK Institute interviewed a representative sample of the adult Swiss population (age ≥18 years, stratified by language region: German-, French- and Italian-speaking, 70, 25 and 5%, respectively) by telephone. There were two interview rounds to account for potential seasonal variations, in May (n = 506) and November 2018 (n = 516). The health-seeking behaviour of these individuals during the previous 2 months was analysed.


In total, data of 1025 individuals were analysed: 51% females, median age 52 years (range 18−85). During the preceding 2 months, per 1000 adults, 546 had at least one symptom, 184 reported several symptoms, 243 sought medical advice, 164 first contacted their general practitioner, 81 directly contacted a specialist in a private practice, 16 were self-admitted to an accident and emergency department, 17 firstly contacted a pharmacy and 6 contacted an alternative medicine healthcare provider. In total, 21 persons were admitted to a hospital, of whom 8 underwent surgical procedures, 18 were at first transferred to a regular ward and 3 required intensive care unit services. Because of their current health problem, 387 individuals took medication and 259 bought their medication themselves. The vast majority (95%) of subjects was registered with a general practitioner.


This study represented an attempt to map the healthcare utilisation of the Swiss population. These results may be useful for further delineation of healthcare policies and medical education to meet the demand and needs of people in Switzerland. They indicate that general practitioners are the most important healthcare resource in Switzerland. Compared with specialists, they provide twice as much health advice at less costs. To optimise the health care system in Switzerland, we suggest to allocate resources where they are most needed.


  1. De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, et al. Switzerland: Health system review. Health Syst Transit. 2015;17(4):1–288, xix.
  2. eurostat. Mortality and life expectancy statistics in 2017 2019. Available from:
  3. Herzlinger RE, Parsa-Parsi R. Consumer-driven health care: lessons from Switzerland. JAMA. 2004;292(10):1213–20. doi:.
  4. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall. How the performance of the US Health care system compares internationally. New York: CommonWealth Fund; 2014.
  5. OECD. Health policy in Switzerland 2017 [cited 2019 November 25]. Available from:
  6. Thomson S, Jonathan C, Tamás E. Can people afford to pay for health care? New evidence on financial protection in Europe. Copenhagen: World Health Organization Europe; 2019.
  7. Swiss Federal Statistical Office. Health care costs and financing 2017: provisional data. Neuchâtel: SFSO: 2019.
  8. Camenzind M. [“You cost too much! Now finally save!”]. Krankenpfl Soins Infirm. 2012;105(10):10–3, 46–9, 66–9. In French, German, Italian.
  9. Federal Office of Public Health. Medreg [cited 2019 10. September].
  10. Senn N, Ebert S, Cohidon C. Analyse et perspectives sur la base des indicateurs du programme SPAM. OBSAN Dossier 55. Neuchâtel: Schweizerisches Gesundheitsobservatorium (Obsan); 2016.
  11. Schäfer WL, Boerma WG, van den Berg MJ, De Maeseneer J, De Rosis S, Detollenaere J, et al. Are people’s health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Prim Health Care Res Dev. 2019;20:e104. doi:.
  12. Medienmitteilung der mfe. Medizinische Grundversorgung: Neue Studie prognostiziert rasant steigenden Hausarztmangel mit hohen Kostenfolgen
  13. Pichlhöfer O, Maier M. Unregulated access to health-care services is associated with overutilization--lessons from Austria. Eur J Public Health. 2015;25(3):401–3. doi:.
  14. Stewart M, Ryan B. Ecology of health care in Canada. Can Fam Physician. 2015;61(5):449–53.
  15. Green LA, Fryer GE, Jr, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Engl J Med. 2001;344(26):2021–5. doi:.
  16. Hansen AH, Halvorsen PA, Førde OH. The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals. J Public Health Res. 2012;1(2):177–83. doi:.
  17. White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;265(18):885–92. doi:.
  18. Leung GM, Wong IO, Chan WS, Choi S, Lo SV ; Health Care Financing Study Group. The ecology of health care in Hong Kong. Soc Sci Med. 2005;61(3):577–90. doi:.
  19. Pichlhoefer O, Kutalek R, Spiegel W, Shibamori Y, Zehetmayer S, Maier M, eds. The Ecology Of Medical Care In Austria2011; Warsaw.
  20. Shao CC, Chang CP, Chou LF, Chen TJ, Hwang SJ. The ecology of medical care in Taiwan. J Chin Med Assoc. 2011;74(9):408–12. doi:.
  21. Shao S, Zhao F, Wang J, Feng L, Lu X, Du J, et al. The ecology of medical care in Beijing. PLoS One. 2013;8(12):e82446. doi:.
  22. Tsuguya F, Mahbubur R, Osamu T, Mayuko S, Takuro S, Hiroyoshi E, et al. The Ecology of Medical Care in Japan. JMAJ. 2005;48(4):163–7.
  23. Federal Statistical Office. Structural Survey [cited 2019 16. September].
  24. T. S. Weighting survey results. J Mark Res Soc. 1986;28:269–84.
  25. Federal Statistical Office. Population and Households Statistics, 2010-2017 2018. Available from:
  26. Federal Statistical Office. Arbeitsmarktstatus nach Geschlecht, Nationalität, Altersgruppen, Familientyp 2019. Available from:
  27. Federal Statistical Office. STATPOP. Permanent and non-permanent resident population by institutional units, citizenship (category), sex and age 2016. Available from:
  28. Lumley T. Analysis of Complex Survey Samples. CRAN Repository. 2019 [updated 2019-04-27; cited 2019 25th October]. Available from:
  29. The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys 9th edition. AAPOR 2016. Available from:
  30. OECD. Health Care Resources 2019 [cited 2019 August ]. Available from:
  31. Ferro A, Kristiansson PM. Ecology of medical care in a publicly funded health care system: a registry study in Sweden. Scand J Prim Health Care. 2011;29(3):187–92. doi:.
  32. Fukui T, Rahman M, Ohde S, Hoshino E, Kimura T, Urayama KY, et al. Reassessing the Ecology of Medical Care in Japan. J Community Health. 2017;42(5):935–41. doi:.
  33. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. doi:.
  34. Gravelle H, Morris S, Sutton M. Are family physicians good for you? Endogenous doctor supply and individual health. Health Serv Res. 2008;43(4):1128–44. doi:.
  35. Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, et al. Explaining differences in English hospital death rates using routinely collected data. BMJ. 1999;318(7197):1515–20. doi:.
  36. Wennberg JE, Fisher ES, Skinner JS. Geography And The Debate Over Medicare Reform: A reform proposal that addresses some underlying causes of Medicare funding woes: geographic variation and lack of incentive for efficient medical practices. Health Aff (Millwood). 2002;21(Suppl1):W96–112. doi:.
  37. Kravet SJ, Shore AD, Miller R, Green GB, Kolodner K, Wright SM. Health care utilization and the proportion of primary care physicians. Am J Med. 2008;121(2):142–8. doi:.
  38. Gulliford MC. Availability of primary care doctors and population health in England: is there an association? J Public Health Med. 2002;24(4):252–4. doi:.
  39. WHO. Primary health care WHO Newsroom2019 [updated 27 February 2019; cited 2019 11th October]. Available from:
  40. Petterson SM, Liaw WR, Phillips RL, Jr, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503–9. doi:.
  41. White KL. The ecology of medical care: origins and implications for population-based healthcare research. Health Serv Res. 1997;32(1):11–21.
  42. Groenewegen P, Heinemann S, Greß S, Schäfer W. Primary care practice composition in 34 countries. Health Policy. 2015;119(12):1576–83. doi:.
  43. Freund T, Everett C, Griffiths P, Hudon C, Naccarella L, Laurant M. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world? Int J Nurs Stud. 2015;52(3):727–43. doi:.
  44. Buchan J, Dal Poz MR. Skill mix in the health care workforce: reviewing the evidence. Bull World Health Organ. 2002;80(7):575–80.
  45. Josi R, De Pietro C. Skill mix in Swiss primary care group practices - a nationwide online survey. BMC Fam Pract. 2019;20(1):39. doi:.
  46. Dovey S, Weitzman M, Fryer G, Green L, Yawn B, Lanier D, et al. The ecology of medical care for children in the United States. Pediatrics. 2003;111(5 Pt 1):1024–9. doi:.

Most read articles by the same author(s)

1 2 > >>