The Swiss don’t rush to see the doctor for every little scrape. The OECD estimates that they average four doctor visits a year, much less than in France (seven times) and Germany (10 times). But that is not because they have anything against the Swiss healthcare system. It would appear to be more of a question of money. Doctor visits are expensive. Designed to encourage “health consumers” to be more accountable about their health, deductibles and co-payments have the sometimes reverse side effect of dissuading uncertain patients. As they know that they will have to cover the first few hundred francs, some people think twice before having that lingering cough checked out. Then they end up hospitalised in expensive emergency rooms with pneumonia.
Although regular follow-up comes at a financial cost for most, it is out of reach for a whole swathe of the population considered “in a situation of vulnerability” (p.17). Social disparities, especially poverty, but also isolation, disability, illiteracy, immigration and many others are well known for having a major impact on health. Certain conditions or life paths, such as prison time (p. 26) or refugee status (p. 21), can make a significant difference. The effect of other situations, such as long Covid (p. 37), is not yet fully understood, but they are already doing substantial damage, even among the traditionally less vulnerable segments of the population. No one is immune to one day finding themselves in a position of vulnerability, either temporary or chronic.
The hospital is aware that early intervention with these populations is an opportunity to deal with situations before they get out of hand. The healthcare authorities, especially in the canton of Vaud (DSAS), provide a number of general outreach services, including social work, public housing, consultations with specialists, grants and much more, to access people who would otherwise slip through the healthcare system. But when people have trouble making ends meet every month, why should they worry about the long-term consequences of what for now just a little health problem? /
