05.08.2026

Making decisions when space is tight: How we should allocate scarce resources in the healthcare system

«Life is priceless» – that’s a belief we’re happy to hold on to. The reality is quite different, even in Switzerland.

Switzerland is one of the countries with the highest healthcare expenditure in the world. Per capita, this amounts to around 10,000 USD per year, compared with an OECD average of 6,000 USD. In total, Switzerland currently spends around 12 per cent of its gross domestic product on the healthcare system, whilst the OECD average stands at 9.3 per cent. It is difficult to answer objectively whether this amount is appropriate. One thing is clear, however: even in one of the world’s wealthiest countries, human and financial resources are limited – and not just in the healthcare sector – because, unfortunately, every franc can only be spent once.

This is precisely the subject of the latest feature article by the Swiss Academy of Medical Sciences (SAMW). In it, Prof. Christoph A. Meier, an internist, endocrinologist and CMO of VIVA Health Swiss, describes how economic incentives in the healthcare sector determine where money and staff actually go – and how significantly these incentives can diverge from the actual health benefits for the population.

When incentives crowd out benefits

An example from the UK brings the problem into sharp focus: the National Institute for Health and Care Excellence investigated the health impact of new immunological and oncological medicines introduced between 2000 and 2020. The conclusion was clear: overall, these drugs displaced more health benefits elsewhere in the system than they generated themselves. It is estimated that around 1.25 million so-called quality-adjusted life years (QALYs) were lost as a result, because this implicitly meant that funds were not available for other areas with higher potential benefits.

This pattern is also evident in the field of prevention. Lung screening using low-dose CT scans for smokers has been shown to save lives, but costs around 80,000 USD per QALY gained. Smoking cessation programmes achieve a significantly better cost-benefit ratio at around 5,000 USD per QALY. Nevertheless, such programmes are rarely offered in many places because they are not financially attractive to providers.

Health does not primarily arise within the healthcare system

An often underestimated point: the so-called social determinants of health – that is, socio-economic factors such as education, work, housing and behaviour – account for 80 per cent of a population’s health, whilst only 20 per cent can be directly attributed to medical care. This puts into perspective the importance often attributed to cutting-edge medicine in public debate and suggests that the optimal allocation of resources must be considered beyond the narrow confines of the health sector.

What a different approach would entail

Meier advocates a change in the system: away from a remuneration model based primarily on the number of services provided, towards competition based on transparent metrics of the actual «impact on outcome». Prerequisites for this would include, amongst other things, more comprehensive and automatic recording of treatment results (‘outcomes’), as well as a systematic Health Technology Assessment (HTA), which is currently less firmly established in Switzerland than would be desirable for a country at the forefront of medical care.

This is evident, for example, in the treatment of localised prostate cancer. Watchful waiting, surgical removal and radiotherapy show similar 15-year survival rates, but differ significantly in terms of side effects such as incontinence or impotence. The choice of treatment should be determined as part of a shared decision-making process with the patient, independently of the economic pressures affecting the individual disciplines involved. Funding should be structured in such a way that the treatment plan best suited to the patient takes precedence, rather than competition between different organisations for particularly lucrative individual services.

A question that affects all service providers

The article makes it clear that the debate on resource allocation is not a purely academic one. It affects everyone in our healthcare system who, together with patients, decides on a daily basis how best to utilise our finite human and financial resources. As long as a large proportion of remuneration is based on individual services, there remains a strong temptation to invest where these services can be billed most profitably, rather than where they deliver the greatest benefit to the population as a whole.

Source: Meier, C. A. (2026). Staffing and Finance: Reflections on the Allocation of Scarce Resources. SAMW Bulletin, 2/2026, pp. 3–5.

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