Demographics and Healthcare
Switzerland is a country of 8.6 million inhabitants [12] in the
heart of mainland Europe. Surrounded by members of the European Union
(EU), despite all contractual obligations, from legal standpoint the
country is technically independent of the EU and therefore not subject
to the EU-law per se . Divided into 26 Cantons, the principle of
federalism is deeply enshrined in the political system. It allows every
Canton to issue own decrees legally binding within its border. The
country’s highest executive authority is vested in the Federal Council
(Bundesrat), a panel of 7 representatives forming the government of
Switzerland. The legal framework on planning and acting in case of a
pandemic is adopted in the law on Epidemics (6) transferring full
executive, legislative and judicial power to the Federal Council to
issue nationwide regulations on top of cantonal decrees. The
well-structured political system, federalist concept and short
information chains and distances across the country all contribute to
Switzerland being a country known for its good organization, an
important prerequisite for successful crisis management.
There are 1.6 million inhabitants (18.7%) in Switzerland over 65 years
of age, a risk population for COVID-19 infections. Around 29.6% of
deaths in the male and 33.1% in the female population have a
cardiovascular origin [13]. The healthcare system is based on a
compulsory health insurance. As of 2018, Switzerland had 281 hospitals,
102 of them providing general healthcare to the public [14]. Five
Hospitals (Zurich, Berne, Basel, Geneva, Lausanne) are instituted by a
University and are considered tertiary hospitals.
Currently, 16 centers do perform cardiac surgery in Switzerland, with
three covering the full range of surgical procedures including heart
transplantations. A few hospitals have a well-established extracorporeal
membrane oxygenation (ECMO) program. Hosting the Transplant- and
Mechanical-Support-Program in the northeastern part of Switzerland, USZ
is known to have a broad expertise in ECMO therapy including airbound
interhospital transfer of critically ill patients [15]. In 2015 in
Switzerland altogether 6,901 patients underwent cardiac surgery [16]
with lax national regulations on patient-flow, lack of
patient-centralization and high dependency of smaller hospitals on
personal referrals.