Switzerland has one of the world’s highest quality healthcare systems – but also one of the most expensive. As the country faces rising healthcare costs, an ageing population and growing pressure on household budgets, investing in prevention could enable better health outcomes alongside making better use of scarce resources. Why, then, does prevention remain relatively marginal in terms of healthcare spending? We spoke to Joachim Marti, Associate Professor of Health Economics at the University of Lausanne and Unisanté, about what it would take to make prevention a more central part of the Swiss healthcare system.

The current state of preventive care in Switzerland

Spending on prevention can be difficult to measure, because the field encompasses a wide range of activities, some of which are easier to track than others: investment in immunisation and public health programmes, for example, is easier to trace than initiatives in adjacent fields such as education and urban planning.

Nevertheless, the overall picture is clear: Switzerland has a sophisticated and well-funded healthcare system, but it’s not focused on preventing disease. ‘Switzerland spends around 12% of GDP on healthcare, well above the OECD average,’ Joachim told us. ‘Yet less than 2% of healthcare expenditure is allocated to prevention, compared with roughly 3–4% across other OECD countries.’

Indeed, it’s not just about how much Switzerland spends on prevention, but how its healthcare system is structured. Notably, the legal and financial framework is largely focused on healthcare delivery and health insurance: treating patients, conducting tests and organising inpatient and outpatient care. The dominant fee-for-service model rewards these activities, rather than maintaining population health.

But, in Joachim’s view, both areas need to come together in an integrated, sustainable system: ‘Prevention and treatment shouldn’t be seen as competing priorities, they’re both important. As things stand, Switzerland could do more to prevent illness – we’re not succeeding there yet.’

Barriers to adopting a more preventive model

As Joachim outlined, there are several structural barriers around investing in preventive activities today. The first is the mismatch between when costs are incurred and when benefits materialise. ‘Prevention requires investment now, but many of its benefits may only emerge years or even decades later,’ he said. ‘This creates a challenge when policymakers and healthcare providers are allocating scarce resources.’

Added to this, prevention is much harder to communicate and evaluate than treatment: the latter involves an identifiable patient receiving care and, ideally, getting better, while prevention reduces risk across a population, which means its success is often an absence – fewer people developing a disease, getting hospitalised or dying prematurely.

The visible value of preventive interventions can therefore be difficult to point to, a fact that is exacerbated by the comparative weakness of the evidence base. Despite prevention’s rapid evolution as a field, Joachim shared that there has been a lack of rigorous studies measuring both short- and long-term effects of interventions. ‘Building this evidence base is essential if prevention is to be treated as a credible investment, rather than simply an additional expenditure,’ he argued.

Finally, the costs and benefits of prevention are often fragmented across different organisations and sectors. For example, an insurer may invest in prevention today, but the benefits will likely materialise years later, potentially after individuals currently enrolled on plans have moved to another insurer. This makes it harder to coordinate investment in prevention and capture its full economic value. As Joachim put it: ‘This fragmentation creates a thorny question – who pays, and who benefits?’

Why we need to invest in prevention now

Against this backdrop, it’s crucial to consider the return on investment prevention can bring. There is, in fact, a strong economic argument for preventive measures: people who remain in good health can stay in the workforce longer, be more productive and contribute to the wider economy. Joachim pointed to OECD projections  that suggest reducing risk factors through prevention could cause long-term health expenditure in Switzerland to fall by around 2–3%, while GDP could rise by around 0.5% by 2050 (though he also underlined that the relationship between healthcare spending and prevention is complex, as people who live longer may end up using healthcare services for more years).

Nevertheless, Joachim stressed that the primary benefit of prevention actually centres on better health and quality of life. ‘Prevention doesn’t need to save money to be worthwhile: its fundamental purpose is to help people remain healthier for longer,’ he said. As part of this, he highlighted that new treatments are generally evaluated based on whether they provide sufficient health benefits relative to their cost, arguing that prevention should be assessed according to the same cost-effectiveness standards. ‘Cost savings should be seen as an additional benefit, rather than a prerequisite for investment,’ he affirmed.

On the flip side, the consequences of underinvestment in prevention are stark. ‘We’ve already seen that during periods of economic pressure, prevention is among the first areas to face budget cuts – after all, it’s not like treatment can simply be postponed for patients who are already ill,’ Joachim said. ‘But this risks creating a cycle in which resources are always concentrated on treating disease rather than maintaining health. In the long term, this doesn’t just mean shorter lives, but longer lives with fewer healthy years – in terms of both physical and mental health.’

What the system of the future might look like

‘A Swiss healthcare system centred on prevention requires both better prioritisation and structural reform,’ Joachim stated. First, the government and cantons need a more coherent way of identifying high-value prevention strategies. Proven ‘best buys’, targeting factors like tobacco, physical inactivity and diet, should be prioritised, while ineffective or low-value interventions should be avoided. Stronger evidence and evaluation would help direct resources towards what actually improves population health.

But true change requires a more fundamental shift: prevention needs to become an explicit objective of the healthcare system. According to Joachim, this could take the form of a federal health law, alongside the existing health insurance framework, which would establish maintaining and improving population health as a national priority. ‘As things stand, we see local, fragmented efforts from individual cantons, insurers and other actors. But we need a centralised, federal framework: we’re only a country of 8 million after all, we don’t need 26 different strategies.’

This would go hand in hand with sweeping changes in the way healthcare is financed.

Transforming Switzerland’s predominantly fee-for-service model in favour of approaches that give providers responsibility for the health of defined populations could encourage longer-term investment in prevention. Similarly, reducing or eliminating cost-sharing for high-value preventive services could address financial barriers, particularly for lower-income households, and improve health equity.

Overall, Joachim described a system that is ‘more proactive than reactive’: one that ‘invests more in prevention and primary care, coordinates resources across cantons, uses data to measure outcomes and focuses on value rather than simply the volume of healthcare activity’. In the long term, this really could help people live healthier, happier lives. In fact, when underpinned by an integrated, centralised model, prevention becomes much more than another healthcare expense: it’s an investment in the health, productivity and long-term sustainability of society.