“In a certain sense, medical care is made to measure – every patient is individual”

For a number of years now, the cantons have been committed to the principle of “outpatient before inpatient”. How much pressure does this put on Hirslanden Group?

That doesn’t just put considerable pressure on us, but on the entire healthcare system. In principle, this trend is on the right track. A large proportion of surgical procedures and other medical interventions as well can be performed on an outpatient basis. This is the cheaper and faster way, and it’s not significantly worse in terms of patient comfort.

It sounds a bit “drive-through”, though.

Agreed, but patients usually like that. After all, who wants to spend time in a hospital? The question is simply one of how to introduce “outpatient before inpatient”, at what speed and at the risk of which consequences.

Is the system infrastructurally prepared for this?

No, there are too few functioning outpatient surgery centres. But that’s only one aspect. Another one is: at what tariff can you offer this? According to the existing Tarmed tariff schedule, outpatient surgery is poorly remunerated. Patients who would otherwise be treated in the expensive inpatient infrastructure will more and more have their operations conducted on an outpatient basis, but with expensive personnel, expensive processes, expensive material, and all this at a rate that doesn’t really cover costs. This has already left enormous skid marks on the system – and at all hospitals in Switzerland.

You once said that Hirslanden doesn’t view their patients as “customers”, but rather as “guests” – why that?

Even the term “customer” is a step in the right direction, because the terminology used previously in hospitals sounded like it came from the penal system: admission, dismissal, transfer. The “patient” is the sufferer, and for many decades this term was considered an appropriate description in the healthcare system. Nevertheless, the change of perspective from “patient” to “customer” is at least correct: hospitals are service providers, simply with another kind of relationship with the customer. In a certain sense, medical care is made to measure – because every patient is individual.

So what’s then the difference to “guest”?

We shouldn’t kid ourselves: we’re selling a service that nobody really wants. Who goes to a hospital willingly, where it’s about illness, pain, fever, medication. That’s why a differentiated understanding of what most people would call a “customer” is so important to us.

You yourself practiced as a doctor for quite a long time. How close are you to the patient these days?

Unfortunately, not as close as I used to be. But especially from my emergency medical care experience, I was able to learn a lot about management. There are many parallels: you’re always in the limelight, teamwork is indispensable, you have to make decisions and live with the consequences. Communication skills are just as important. And, perhaps most of all, you have to be able to deal with stress. All things considered, there’s nothing that I’ve ever done more gladly than work in the emergency room. But I don’t regret my later career. Everything has its time in life.

Where does Hirslanden have room for improvement?

The interface between the clinic and the physicians who treat patients after their hospital stay; in other words: exit management. But we’re working on this and are continuously interviewing all our patients – for the past two years, even on an international scale.

How have the demands of patients changed over the past decade?

What’s really changed is their level of knowledge. They sometimes come to the doctor and, in questionable cases, know more about what they suspect is the tentative diagnosis than their doctor does – which can really put him in an awkward situation.

Are there also advantages to this heightened patient knowledge?

Certainly. The knowledge asymmetry between doctor and patient used to be huge. The doctor could attempt to level things out by acting empathetically – or not even go there by simply coming across as “God in white”. However, the doctor-patient relationship suffered as a result. This kind of condescension is less pronounced today. There are probably doctors who don’t like the fact, but if you want to discuss things on a par with patients, it’s an advantage if they already know something.

Costs are the big issue in healthcare these days. Where can savings be achieved?

In the Swiss healthcare system, it would be possible to reduce costs without really losing anything. But this requires a socially and politically initiated discourse on what solidarity-based financing means. Our healthcare plans work like comprehensive collision coverage on your car. At the moment, this can be half-decently financed – but for how long?

What do you propose?

There should be a catalogue of basic services financed collectively. Anything that is not included, should be privately insured in a modular fashion. This may not yet be capable of gaining majority backing, but it’s a realistic scenario for the future.

The discussion about costs always boils down to the expensive measures taken late in a person’s life. What are your personal thoughts on this?

I don’t really prefer to skate on this thin ice. But I actually believe that the issue finally needs to be settled by the general populace. For the time being, everyone has to figure it out for themselves. I don’t think highly of the discussion about putting a price tag on years of life. That would be a mistake. But we need to face up to the issue. In 30 or 40 years, life expectancy will be over 90. We’ll be surrounded by centenarians who are still relatively fit and, of course, entitled to appropriate medical care; for example, receiving a new kidney if theirs fails.

Ethically, a sticky wicket indeed. How should this discussion be kick-started?

One thing’s clear: any politician who dares even a whisper about the subject today is out of a job tomorrow. So somehow it needs a social effort, a kind of crowd-backing effect. I don’t know when that might come about. The simple fact is that presently, there’s still a lot of money in the system and the degree of suffering is therefore comparatively low.

But the public seems ready to start a discussion when it comes to the astronomic prices for drugs that treat rare diseases.

Right. That’s the iceberg syndrome kicking in: something sticks out that’s quite obvious; forget about what’s below the surface. Everyone thinks: “OMG – so many thousands of francs for a hepatitis C medication!” But at least it takes the discussion in the right direction.

If fundamental research were to be allowed at Hirslanden Group, in which field should it be?

In principle, fundamental research is the bailiwick of the universities. Personally, I’m firmly convinced that one day we’ll get cancer under control. My other great hope is that we’ll no longer be dependent on organ donations, but instead that organs can be made from stem cells. It’s doable, so let’s do it.