On behalf of BMS
On behalf of BMS, the gfs.bern research institute conducted a study to assess public opinion on the issue of highly effective but very expensive treatments.
The aim was to discover how Swiss residents aged 18 and over feel about such treatments, what role solidarity and the Swiss healthcare system play here, and to record opinions on possible criteria for receiving a treatment.
For this purpose, somewhere over 1,000 people were surveyed in a mixed-mode setting (telephone and online panel) in all three language regions of Switzerland (German, French and Italian).
The online interviews were conducted between 12 and 26 August 2024. During this period, respondents received one email reminder to complete the survey.
Further details on the method used for the survey can be found in the info box at the end of the cockpit.
Information status
The resident Swiss population generally feels (very) well informed about the healthcare system. This is confirmed by three aspects of the healthcare system about which a very significant majority feel very well or fairly well informed.
Ninety-two percent state that they are (very) well informed about how they can lead a consciously healthy lifestyle. Eighty-one percent state that they are able to decide when they should go to the doctor or if can recuperate by themselves at home. And 77% say that they understand the side effects of a medicine as stated on the package leaflet.
Overall, (political) decisions regarding the Swiss healthcare system are therefore made on the basis of a general feeling of being sufficiently well informed. This is important insofar as the complexity of information disseminated during direct democratic decisions tends to favour retaining the status quo and, therefore, to the rejection of reforms.
Access to healthcare services
A majority of 55% also agree with the statement that everyone in Switzerland has equal access to healthcare services.
Eighteen percent strongly agree with this while 37% agree. Twenty-eight percent disagree with the statement and 15% strongly disagree.
In the language regions, we observe significant differences between German-speaking Switzerland and French-speaking Switzerland: While around 60% in German-speaking Switzerland strongly agree and only 11% strongly disagree, only around 45% in French-speaking Switzerland agree and 30% strongly disagree. This more critical view from French-speaking Switzerland echoes a finding of recent years. In French-speaking Switzerland in particular, healthcare costs have reached a painful level. This has shifted the discussion somewhat away from the quality of service and more towards a discussion of costs, bringing about an attendant increase in critical voices.
Benefit–cost ratio
The Swiss healthcare system is known for providing very good services on the one hand, but also for being expensive on the other.
Sensitivity to costs is crucial for new treatment methods that have evident cost implications. And these are clearly evident: When asked whether the benefit–cost ratio is right, two thirds of the population (66%) say that the costs (slightly/strongly) outweigh the benefits. Only 12% state that the benefits outweigh the costs. Twenty percent state that the benefit–cost ratio is balanced.
A relative majority of 37% state that the costs rather outweigh the benefits.
Men are significantly more critical of the benefit–cost ratio than women. While younger people are significantly more critical of the benefit–cost ratio than older people.
Increase in health insurance premiums
One repeatedly discussed solution for achieving better cost control is to investigate behavioural cost sharing models.
Just one behavioural approach garners a slim majority of 52%: A slim majority agree or strongly agree that an increase in the individual premiums for people who regularly consume tobacco products makes sense. Forty-four percent are of the opposite opinion.
Relatively slim majorities agree that non-compliance with one’s own doctor’s medical recommendations (47%) or regular alcohol consumption (44%) should be linked to an individual increase in premiums.
Exercising less than twice a week (38%) or regular sugar consumption (32%) should not be associated with a premium increase.
Overall, the picture that emerges in 2024 is one that has long been observed with regard to behavioural cost sharing: Acceptance is declining with increasingly widespread concern.
Importance of solidarity
The principle of solidarity in the healthcare system should fundamentally not be shaken up.
The principle of solidarity is very important for 47% and of average importance for 37%. Only 13% consider the principle of solidarity to be of little importance or not important at all.
Even within different subgroups, e.g., when classified by gender, age or language region, opinions differ only minimally.
When broken down by sympathies to political parties, a clear left-right divide emerges in this survey. While SP and Green sympathisers are very much in favour of the principle of solidarity, this is less so for FDP and SVP sympathisers.
Solidarity with groups of people
Solidarity in the Swiss healthcare system is reflected, among others, in the benefits provided by compulsory health insurance. However, it is also conceivable that certain groups of people pay more than others.
A slim majority believe that two groups of people should pay more: People with a high income or greater assets (53%) and people that lead a very unhealthy lifestyle (50%).
For three groups, between 25% and 40% agree that the state should pay more: People over 80 years of age (25%), people who are suffering long-term sickness (32%) and people who need very expensive medication (40%).
Access to new treatments
In the case of highly effective, but also very expensive treatments, Swiss residents clearly agree on one thing: Everyone should have equal access to appropriate innovative treatments. Costs should not be the deciding factor (84%). Only 10% tend to disagree with this.
Two opinions are more polarised. While 46% agree that access to such treatments should be based on fixed criteria, thereby excluding certain people, 47% are of the opposite opinion. Equally polarised is the opinion that our healthcare system cannot afford to make these treatments available to everyone (44% agree and 51% disagree).
A majority is against a cost cap that passes on the costs to the patient once the threshold has been reached (or if it means discontinuing treatment; 66% disagree).
Among the two polarised opinions (i.e., fixed criteria and healthcare system cannot afford it), opinions are also divided according to socio-demographic and political variables.
Fixed criteria for access to such treatments are much more popular in German-speaking Switzerland than in French- or Italian-speaking Switzerland. Men are also more in favour of this idea than women. Younger people are also comparatively more in favour than older people. Finally, people on the political-ideological right (i.e. SVP and FDP sympathisers) are more likely to see this idea as sensible than people on the “left”.
And in German-speaking Switzerland, people are more convinced than in other language regions that the healthcare system cannot afford to give everyone access to such treatments. Politically and ideologically, more people on the right-wing are also more likely to agree with this than left-leaning people.
Upper cost threshold for treatments
People are fundamentally against a cost cap for very expensive treatments. However, various aspects, such as the value attached to an additional year of life or the time following recovery, also play a central role, especially if a specific price (here CHF 150,000 as an example) is included in the assessment.
Three statements attract very strong agreement:
Two statements on the “value of an additional year of life” also receive clear majority support:
Ultimately, opinions are divided when it comes to the financial value of an extra year of life for 80-plus-year-olds and in the event of recovery:
While 46% believe that a treatment should only cost more than CHF 150,000 if the patient is younger than 80, 42% disagree.
This opinion is held primarily by people in German-speaking Switzerland and people from the centre-right camp rather than those on the left.
And while 40% believe that treatment should only cost more than CHF 150,000 if the patient subsequently recovers, 50% are of the opposite opinion.
This opinion is held comparatively more by men than by women, more by older people than by younger people, by FDP sympathisers than by sympathisers of other parties, and generally more by people for whom the idea of solidarity in the healthcare system is of little importance.
General criteria
Even if price is not to be the sole decisive factor in making a decision regarding access to treatment, Swiss residents do not want to make expensive but effective treatments available to everyone without restriction. They believe that a range of individual requirements should be taken into consideration.
In general, a clear majority is in favour of various criteria: Seventy-eight percent consider the general state of health, 69% the remaining lifespan following treatment, 65% a person’s age and 65% individual lifestyle as very good or moderately good criteria.
While individual prerequisites meet with high approval as criteria, such criteria that take the behaviour of the patient or patients into consideration do not always enjoy majority support.
Behavioural criteria
A clear majority agrees that there should be an obligation to follow all of the doctor’s instructions during treatment (85% agree) and to follow all of the doctor’s recommendations for improving one’s own lifestyle (78% agree).
Two polarising behavioural instructions exist: namely that a patient should be prepared to make an additional contribution to the cost of treatment (47% agree vs. 47% disagree). The pro side of this statement tends to exist more in German-speaking Switzerland, among older people and among centre-right oriented people.
The statement that a patient should fundamentally not be subject to any obligations at all in order to receive treatment also polarises opinion (47% agree vs. 45% disagree). Support for this statement is more likely to be found in French-speaking Switzerland, among older people and among SP sympathisers.
Social and economic criteria
Finally, social and economic criteria can also be used to decide whether a person should receive such a highly effective but very expensive treatment. These meet with a very strong level of agreement:
Decisive factor for treatment
If someone should require expensive innovative treatment, the vast majority are in agreement: Eighty-five percent believe that the doctor should decide whether such treatment should be administered. Seventy-eight percent (also) consider that they should take this decision themselves. Just over half (also) believe that an additional independent medical examiner offers an important expert opinion here (55%).
An independent committee (34%), one’s own health insurance company (29%) or the state (16%) are only rated as suitable decision-makers by a minority.
This also shows that such a decision should be a medical one, with input from the patient concerned, and it should explicitly not be a primarily cost-orientated one.
Potential discussion on solidarity as a central concept
A potentially central discussion about access to innovative and very expensive treatments focusses on solidarity in the Swiss healthcare system. Although solidarity is important to a majority in the Swiss healthcare system, it is not true of everyone.
A multivariate regression analysis can be used to highlight which criteria and statements on access to new treatments are most strongly related to the opinion that solidarity must play a central role in the Swiss healthcare system. Those arguments that do not touch the vertical line at zero are significant.
For those for whom solidarity in the healthcare system is important, one particular argument is also key:
In other words, potential discussions will revolve around the issue of long-term cost savings.
For those for whom solidarity in the healthcare system is of less importance, it is more important for the patient to be able to resume civic commitments following recovery or – if the patient receives expensive treatment – that he or she ultimately makes a recovery.
Potential discussion on the financial impossibility of making these treatments available to everyone
Another potentially central opinion in the discourse on innovative treatments could be that the Swiss healthcare system simply cannot afford to offer such treatments to everyone.
This attitude was also analysed using multivariate regression in order to find out which criteria for accessing these treatments are associated with this opinion.
The following correlations emerged:
So when people who believe that the Swiss healthcare system cannot afford such treatments for everyone are confronted with possible criteria for accessing them, they think that the patients should make an additional financial contribution and that state of health and lifestyle are also important criteria.
However, those who believe otherwise – namely that the Swiss healthcare system is able to provide access for everyone – also believe that patients should not be subject to any obligations whatsoever.
A majority believes that the costs of the healthcare system are greater than the benefits they receive for the amount spent. New cost drivers are therefore viewed rather critically.
Despite the benefit–cost ratio, the principle of solidarity is still strongly anchored in the Swiss healthcare system. Forty percent believe that the state should pay more when it comes to very expensive medication. However, the principle of solidarity is somewhat less of an issue among high-income and wealthy people and those who live an unhealthy lifestyle. Majorities believe that they should generally pay more themselves.
A clear majority believes that everyone should have equal access to innovative treatments, regardless of cost. As a rich country, it should be possible to find financing solutions. Moreover, money could also be saved in the long term. Accordingly, the opinions that fixed criteria should determine access to treatments and whether the healthcare system actually has enough money for everyone to have access to such treatments are also controversial.
Solidarity plays a key role in the healthcare system. The majority therefore also believe that the “(financial) value” of an additional year of life should not even be the subject of discussion. This would be ethically wrong. Accordingly, the population disagrees as to whether people over 80 years of age should receive such very expensive treatment – or whether they should receive it if their chance of recovery is not 100%.
Deciding who should be able access innovative treatments should not primarily be a question of cost. Medical reasons should be taken into account too. Furthermore, a person’s general state of health, remaining lifespan, age and lifestyle should also be taken into consideration, or even used as criteria. In addition to such criteria, access to treatment can also be made subject to conditions: Namely, that patients follow their doctor’s instructions and lead a healthy lifestyle.
In addition to fundamental solidarity in the healthcare system, there are also clear economic arguments in favour of open access to innovative treatments: Patients are not dependent on funds from social insurance schemes, they can once again take on civic commitments, they benefit the Swiss economy as workers and pay taxes.
For those who care about solidarity in the healthcare system, one argument is central: Access to new treatments brings about cost savings in the long term, because patients who have recovered are able to return to work and do not require long-term care. For those who consider solidarity less important, criteria that offer benefits (i.e., civic duties or recovery after treatment) are important. Solidarity will be a central axis of discussion and will also be used to debate the long-term (financial) benefits of treatment for everyone.
Those who believe that the Swiss healthcare system cannot afford innovative and very expensive treatments for everyone will nevertheless find certain criteria for accessing these treatments better than others. Specifically, such people believe that patients should make an additional financial contribution and that a person’s general state of health and lifestyle are important criteria for access to treatments. For those who are even more critical of opening access to these treatments to everyone, patients’ lifestyle is an important criterion alongside finances and state of health.
Client: Bristol Myers Squibb
Population: Residents of Switzerland aged 18 and over who speak one of the three national languages (DE/FR/IT).
Data gathering: Online and telephone survey.
Sample size: Total respondents N = 1,002 (n DCH = 694, n FCH = 247 n ICH = 61)
Weighting: Dual-frame weighting (CATI), language region, gender/age per language region, settlement type per language region, canton, education, party.
Survey period: from 12 to 26 August 2024
Sample error: ±3.1 percentage points at 50/50 and 95% probability.