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ESPN Flash Reports: Swiss parliament votes down a proposal to permanently ban the new admission of doctors

In December
2015, the Swiss
parliament refused
to permanently
ban the new
admission of
doctors. Instead,
the parliament
asked the national
government to
propose a new
solution. The
restriction on the
admission of
doctors will
probably be
extended until
This document has been
prepared for the European
Commission. However, it
reflects the views only of
the authors, and the
Commission cannot be
held responsible for any
use which may be made of
the information contained
Swiss parliament votes down a proposal to
permanently ban the new admission of doctors
ESPN Flash Report 2016/23
In 2001, Switzerland temporarily
regulated the admission of doctors. The
law aimed to restrict
the expected
inward flow of doctors from the EU, as a
potential consequence of the free
movement of people resulting from the
bilateral treaties between the EU and
Switzerland. The national government
has renewed the regulation several times
since, and the current rule will expire on
June 30, 2016.
Originally, the Swiss national
government temporarily banned the new
admission of doctors to fend off an
excessively high influx of practitioners
who might be attracted by
entrepreneurial freedom and well-paid
positions. Indeed, in 2011, one-quarter
of all
doctors working in Switzerland
(30,849) had a foreign degree, and most
of them came from the EU. More
precisely, most doctors migrated from
neighbouring countries of Switzerland
Austria, France, Germany, and Italy (for
instance, most foreign doctors hol
d a
medical degree from Germany [FMH,
Nevertheless, since the 1990s,
Switzerland has faced a considerable
shortage of qualified personnel in the
healthcare sector, amongst them:
doctors. Highly specialised hospitals such
as the Insel-Spital in Bern have trouble
recruiting qualified candidates, especially
for specialist positions. What is more, in
1998, the Swiss government had placed
quotas on application numbers to
medical schools. The Swiss Health
Observatory (Obsan) published warnings
that Switze
rland might only have the
capacity to handle two-
thirds of the
necessary consultations by 2030.
Therefore, the Swiss healthcare system
needs the immigration of professionals
from other countries (Swissinfo).
The current law bans all doctors who are
not registered with the obligatory health
insurance, or have not worked for at
least three years at a Swiss institution of
advanced training from admission to free
practice in Switzerland. Deviations from
this rule are possible because the
subnational governments
(cantons) can
decide not to implement the ban in view
of their competencies to pass laws or
implement federal legislation in many
policy areas. Furthermore, cantons can
decide to admit a doctor within the
canton only or doctors can take over the
of another doctor and the
admission to practice along with it (FMH,
In December 2015, the federal
parliament voted down a proposal that
would have made the current legislation
permanent and would have allowed the
cantons to continue to ban the admission
of new specialists. This proposal had
already entailed a compromise as it
focused on the admission of specialists
only, while the national government’s
initial vision was to extend the
permanent ban to all doctors. The votes
of the Liberal Party (FDP) and the right-
wing Swiss Nationalist Party (SVP)
carried the decision against the proposal.
Further reading
Britt, C. (2012): Foreign doctors bail
out Switzerland,,
FMH (2008): Monitoring der
Spitalärztinnen und ärzte, Swiss
Medical Association,
FMH (2013): Update zum
Zulassungsstopp Inkraftsetzung per
1. Juli 2013,
FMH (2014): FNH lehnt unbefristeten
Zulassungsstopp ab, Swiss Medical
Forster, Christoph (2015a): Definitive
Lösung Aerztestopp, NZZ Neue
Züricher Zeitung, April 20, 2015.
Forster, Christoph (2015b):
Uebergangslösung für Aerztestopp soll
definitif werden, NZZ Neue Züricher
Zeitung, April 28, 2015.
NZZ (2016): Aerztestopp für drei
Jahre Kommission für
Wiederaufnahme, NZZ Neue
Züricher Zeitung, January 23, 2016.
Philipp Trein, University of Lausanne
The SVP and the FDP voted
against the proposal to regulate
the admission of doctors, as they
want more competition and
style arrangements.
According to thes
e two parties,
such reforms would help to
contain costs for healthcare a
key policy challenge in
Switzerland (Forster 2015a,
2015b). In addition, the National
Medical Association (FMH) and the
Swiss Association of Health
Insurers supported a temporary
striction on new admissions.
Both groups prefer flexible ceilings
to doctoral admission instead of a
rigid ban to ensure the supply of
qualified personnel (FMH 2014,
NZZ 2016).
Since January 2016, the national
parliament has again been dealing
with the iss
ue. It aims to find a
new temporary solution by
creating a package deal that links
the admission of doctors to other
dossiers in healthcare policy, such
as a general increase of cantonal
autonomy in this policy area, a
new classification of prices for
thcare services according to
regions and quality, and a
loosening of the contractual
obligations of doctors and health
insurance bodies. The combination
of these issues led some members
of the Liberal Party to support a
temporary renewal of the ban on
admission of doctors in
parliament because it could at
the same time obtain
concessions in some of the other
dossiers (NZZ, 2016).
Outlook &
The ban on new admission of
doctors was compatible with the
bilateral treaties between
Switzerland and the EU since it
tended to all doctors formally.
Nevertheless, it affected mostly
foreign doctors as they are more
likely to not have worked at least
three years in a Swiss institution
of advanced training, which is a
requirement to be exempt from
the ban. The regulation o
f the
admission of foreign doctors
reflects the dilemma of Swiss
relations with the EU. On the one
hand, there is a demand for
immigration of qualified personnel
from abroad, which requires
Switzerland to have a flexible
policy to remain attractive for
igrants to encourage trained
personnel to immigrate when
there is demand (e.g. by offering
family reunification in
Switzerland). On the other hand,
in recent years the paradigm of
the bilateral relations between the
EU and Switzerland has been
called into
question politically,
notably by the popular vote on
mass immigration (February 14,
2014). It is possible that an end
to the freedom of movement
between the EU and Switzerland
will render the country less
attractive to foreign specialists
and complicate the immigration of
qualified doctors even more.
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Commission with independent information, analysis and expertise on social policies. The topics presented in the Flash Reports are
identified by ESPN experts in the light of significant developments in their countries, or in some cases suggested by the
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Full-text available
Background Cost containment is a major issue for health policy, in many countries. Policymakers have used various measures to deal with this problem. In Switzerland, the national parliament and subnational (cantonal) governments have used moratoriums to limit the admission of specialist doctors and general practitioners. Methods We analyze the impact of these regulations on the number of doctors billing in free practice and on the health costs created by medical practice based on records from the data pool of Swiss health insurers (SASIS) from 2007 to 2018 using interrupted time series and difference-in-differences models. Results We demonstrate that the removal of the national moratorium in 2012 increased the number of doctors, but did not augment significantly the direct health costs produced by independent doctors. Furthermore, the reintroduction of regulations at the cantonal level in 2013 and 2014 decreased the number of doctors billing in free practice but, again, did not affect direct health costs. Conclusions Our findings suggest that regulating healthcare supply through a moratorium on doctors’ admissions does not directly contribute to limiting the increase in health expenditures.
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