Switzerland is a landlocked country in central Europe & is surrounded by Germany on the north, by Liechtenstein and Austria on the east, by Italy on the southeast and south and by France on the west and northwest. Switzerland’s capital city, Bern, is located in the western part of the country. Switzerland is divided into three natural topographical regions: (1) the Jura Mountains in the northwest, rising between Switzerland and eastern France; (2) the Alps in the south, covering three-fifths of the country’s total area; and (3) the central Swiss plateau, or Mittelland, consisting of fertile plains and rolling hills that run between the Jura and the Alps.
Population: 8.1 Million
Live births per year: 86,000
Life expectancy at birth: 85 years (female), 81 years (male)
Percentage of population under 15 years: 15%
Ethnicity: 6.1 Million Swiss and 2.0 Million foreigners
National Languages: German 64%, French 23%, Italian 8%, Romansh 0.5%
Type: universal mandatory health care system with two main types of health insurance, for ambulatory care statutory insurance, for stationary care about 2/3 of people have a statutory insurance and 1/3 have a private insurance. Most hospitals are public, the minority are privately owned, which all provide services to all types of insured patients. Outpatient services are mainly provided by physicians in private practice, however, in the last decades, an increasing proportion of outpatients services are also provided by hospitals.
About two thirds of the medical expenses are generated through ambulatory, outpatient & medical services. For ambulatory service reimbursements TarMed tariff positions are used and no private ambulatory tariffs exist. Thus, access to outpatient services is equal for everybody. For a few of issues like coverage of glasses, dental services, alternative medicine, etc. a private insurance is allowed. TarMed encompasses about 4,000 tariff positions, which label and assess services provided by doctors. About a third of the tariffs concern inpatient services, for which flat rates based on diagnoses related groups (DRGs) are applied. For all inpatient services it is possible to take out an additional insurance, allowing a better room comfort and a treatment by a board certified doctor and not a doctor in training. 90% of all costs to a patient to see a primary care doctor / general practitioner / specialist, is covered by health insurance while 10% has to be paid by the patient. Each calendar year patients have a franchise for ambulatory care, not for inpatient, stationary care. The franchise can be chosen ranging between CHF 300 and CHF 2500. A basic ophthalmic exam including history taking, measurement of best corrected visual acuity, tonometry, slit-lamp and undilated fundus exam costs approximately CHF 100.
Cost to patient of squint surgery under general anesthesia: Outpatient surgery costs are approximately 2000 Euros & are more expensive if the patient stays in the hospital (1-2 days).
Number of Paediatric ophthalmologists: Because there is no formal fellowship for strabismus or paeditric ophthalmology in Switzerland, there is no precise number. Depending on the definition what a strabismologist / paediatric ophthalmologist is, the number varies between 20 and 50 for whole Switzerland.
Major successes encountered in Paediatric Ophthalmology practice
Switzerland has several ophthalmologists who influenced paediatric ophthalmology and strabismology. Johann Friedrich Horner; Professor of Ophthalmology at the University of Zürich, was the first to describe Horner’s syndrome. Joseph Lang, also Professor of Ophthalmology at the University of Zürich, was the first to describe microstrabismus as an entity which cannot be treated. He is mainly known through his excellent book about strabismology (which has been translated into different languages) and the Lang I and II stereotest. Alfred Huber, the Father of Neuro-ophthalmology in Europe, was also Professor of Ophthalmology at the University of Zürich & is mainly known for his pioneering work of electrophysiology of the extraocular muscles. In 2003, Daniel Mojon, Professor of Ophthalmology at the University of Bern, introduced the concept of minimally invasive strabismus surgery, a technique that allows us to perform all types of strabismus surgery (MISS) using only very small conjunctival openings. MISS procedures are now being used in over 40 countries around the world. All major clinics have a paediatric ophthalmologist who is usually also in charge of adult strabismology and neuroophthalmolgy.
Major challenges faced in Paediatric Ophthalmology practice
A considerable proportion of ophthalmologists feel that they are inadequately trained in paediatric ophthalmology and strabismus as they had no opportunity to spend a part of their training in such a department. In part this can be compensated by hiring an orthoptist because they are very well trained, not only in strabismology but also in neuro-ophthalmology. A formal fellowship training in paediatric ophthalmology / strabismology is not available in Switzerland (like for all other subspecialties of ophthalmology).
The income of paediatric ophthalmologists and strabismologists is lower compared to anterior segment surgeons, retinal surgeons or eyelid and lacrimal surgeons. Fortunately, despite that, there are enough paediatric ophthalmologists and strabismologists.