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.