Welcome to the symposium
Prof. em. Bernhard Egger, MD
The role of physicians in society – a leadership role?
Prof. Christoph Gubler,MD
- In his presentation, Prof. Gubler outlined the various roles that physicians play in the modern healthcare system and referred to the CANMEDS concepts and the activities of the Academy of Human Medicine (https://www.menschenmedizin.ch). He particularly emphasized the leadership role, which should be performed less through formal authority and more through setting a good example.
He pointed to a growing gap between ethical principles and economic interests. While the consumer behavior of many patients can hardly be influenced, there is also a lack of social control on the professional side: time and again, there are colleagues who do not adhere to a restrained and responsible approach to prescribing, which leads to a regional oversupply of medical services.
As possible solutions, Prof. Gubler advocated the creation of four to five health regions in Switzerland, a consistent separation between medically indicated services and lifestyle offerings, and the introduction of electronic patient records. He also emphasized the opportunities offered by new technological possibilities such as artificial intelligence. He said it was essential to play an exemplary and leading role. He also emphasized the opportunities offered by new technological possibilities such as artificial intelligence. He said it was essential to raise the profile of doctors as role models and leaders and to actively promote this role.
Why I have chosen to study medicine – my career choice a calling?
Dipl. med. Audrey Kovatsch and Orlando Hürlimann,MD
- Dipl. med. Kovatsch and Dr. Hürlimann discussed the different motivations that drive young people to choose to study medicine. However, these initial ideals often contrast sharply with the reality of the profession, which is reflected, among other things, in the alarmingly high rate of people leaving the profession. They highlighted the increasing cost pressure in the healthcare system, which many doctors in training perceive as a significant disruptive factor. Despite these challenges, they expressed a desire not to lose touch with their patients.
Leadership in healthcare – a management function?
Mr. Kristian Schneider
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In his presentation, Mr. Schneider spoke about the tension between leadership and management in healthcare. In particular, he pointed out that hospitals are increasingly being required – in line with political guidelines – to manage themselves. In practice, this often leads to management being tasked with increasing case numbers, which can result in questionable economic pressure on medical decisions.
From the perspective of H+ – the umbrella organization for Swiss hospitals – the current overregulation is a direct response by politicians to what they are observing in the healthcare sector. There is a fundamental lack of trust among the various players: according to Schneider, there is “zero trust” between the stakeholders. As a result, trust is being replaced by regulation. To counteract this, he called for the targeted building of trust, greater transparency in budget negotiations, and support even for goals that cannot be directly measured.
Particularly noteworthy was his critical observation that in many cases the quality of medical indications is no longer correct – a statement that gives pause for thought about the current direction of healthcare.
With the indication for profitability? Ethical dilemmas in everyday hospital life.
Dr. sc. med. Dipl.-Kfm. (Univ.) Thomas Kapitza
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Dr. sc. med. Dipl.-Kfm. (Univ.) Kapitza devoted his presentation to the current hospital crisis in Switzerland, which he explicitly described not as a quality crisis but as a financing crisis. He explained how economic framing is increasingly shaping the discussion about medical services, focusing on the distinction between medical and clinical indications. While medical indications refer to treatments that are justified on professional grounds, clinical indications also have direct economic relevance in everyday hospital life.
Kapitza pointed out that a dangerous trend is emerging: medical indications – which are difficult to calculate due to their complexity and individual considerations – are increasingly being replaced by controllable and economically more manageable medical indications. This puts pressure on medical judgment to subordinate itself to economic requirements
His description of the phenomenon of “moral distress” among medical leaders was impressive. This emotional strain arises when medically and ethically necessary decisions conflict with economic requirements. Dr. Kapitza warned of the long-term consequences, especially for the next generation of doctors, who could become uncertain about their professional identity as a result.
Finally, he outlined possible solutions that took into account both economic and medical-ethical perspectives. The focus was on setting priorities in terms of healthcare ethics: medical indications must take precedence over economic goals such as hospital profits. At the same time, he referred to normative aspects of healthcare quality—such as certification—which can also be seen as a business opportunity.
The conflict between medical ethics and profit optimization—between medical necessity and economic pressure
Prof. Giovanni Maio, MD and M.A. phil.
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In his presentation, Prof. Maio explained how terminology shapes our thinking and actions – for example, when a hospital is referred to as a “business.” This linguistic shift is an expression of a deeper shift in values: the original means-end relationship between medicine and economics has been reversed. Medicine increasingly serves the economy, rather than economic means serving medical care
Maio sees this reversal as a key cause of inadequate care. Instead of individual attention to patients, there is often a focus on maximizing interventions while minimizing interpersonal interaction—partly because the latter is hardly remunerated. Doctors are often unaware that they are being gradually corrupted by this system. With the introduction of DRG systems, every diagnosis has been given a “price tag,” which turns medical decisions into economic calculations
He was particularly critical of the “negativization of time”: time that would be necessary for relationship-oriented medicine does not appear to be financially worthwhile. This leads to the creeping delegitimization of everything that cannot be quantified – a situation that creates dangerous misguided incentives.
Prof. Maio emphasized that economics must once again become subservient to medicine. Hospitals should not be seen as profit-oriented businesses, but as places of public service. In conclusion, he made an urgent appeal to the medical profession to show backbone and – in the interests of their patients – to actively advocate for medicine that remains committed to ethical principles.
Panel discussion
Dr. phil. I Nicole Frank and the speakers from the first part
Healthcare – Should it be left to the state alone?
Prof. hon. Henri Bounameaux
- Prof. hon. Bounameaux answered the question of whether healthcare should be left to the state alone with a resounding “no.” He argued that the discussion should not be reduced to the dichotomy of “state versus private,” but rather that the real challenges lie in the tension between efficiency and costs.
His presentation focused on analyzing the health policy and structural causes of inefficiency in the Swiss healthcare system. He pointed out that it is not primarily the provider – whether public or private – that is decisive, but rather how sensibly resources are used and structures are designed.
Against this backdrop, he referred to the proposal by the Swiss Academy of Medical Sciences (SAMS) to introduce a constitutional article and, based on this, a federal law on health. In doing so, he ultimately advocated stronger national regulation – which at first glance contradicts the brief answer formulated at the beginning, but in essence underlines the need for clearer framework conditions and better coordination in the healthcare system.
Can the system still be saved? – Indication versus cost constraints
Christoph Bosshard
, MD
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In his presentation, Dr. Bosshard addressed the tension between medical indications and economic cost pressures. He emphasized that determining medical indications is the core task of physicians. Medical decision-making must always be independent of financial constraints.
In addition to introducing appropriate tariffs, Dr. Bosshard also mentioned the consistent implementation of fundamental principles such as sustainability, professional competence, and the responsible use of resources as possible solutions. He made it clear that the determination of indications must not be subject to cost pressures in order to ensure high-quality and ethically acceptable medical care.
Hospital planning in the conflict between quality and profit (“state or market”) – a question of conscience
Prof. Christoph A. Meier,MD
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In his presentation, Prof. Meier emphasized that healthcare issues should be understood less as matters of conscience and more as optimization tasks. He spoke out clearly in favor of applying economic principles to optimize healthcare – but with the important caveat that economic issues should not be turned into ethical ones.
According to Meier, hospital planning should not be guided primarily by moral or political considerations, but should be understood as a question of quality. In this regard, he advocated in particular for the consistent measurement of treatment outcomes and the courage to make these transparent – as a basis for targeted improvements.
Prof. Meier presented the concept of “integrated capitated care” as a forward-looking model. This is based on the principle of paying for time rather than procedures (“pay for time, not procedures”) while evaluating the quality of care using measurable results. This model could better meet both patient needs and economic requirements than the current, largely performance-oriented system.
Swiss Medical Oath – An individual approach to overcome the crisis!!
Prof. em. Dr. med. Bernhard Egger
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In his presentation, Prof. Egger pointed out a paradoxical phenomenon in healthcare: despite the possibility of making profits, there is a continuing interest in increasing patient numbers. The main cost drivers are both administratively controlled and self-motivated expansions of indications. He considered the latter to be the root cause of the real conflict between the pursuit of profit and medical ethics.
He emphasized the importance of the Swiss Medical Oath, which, with concrete elements supplementing the Hippocratic Oath, is intended to counteract the increasing economization of medicine. This oath should be understood as a kind of “constitution” for medical practice. In addition, the growing number of members should strengthen the ability to influence health policy developments.
In conclusion, Prof. Egger called on the medical profession to fundamentally rethink its approach. He argued that healthcare institutions should be run as non-profit organizations in order to fulfil the actual mission of medical care.
Podiumsdiskussion
Dr. phil. I Nicole Frank and the speakers from the second part
Appreciation/summary of the symposium
Dipl. med. Namir Lababidi
