[Impact and risks of cost cutting programs on the quality of hospital care in Switzerland].

Cost-minimization programs in Switzerland either in the public or the private sector have impact on quality and accessibility of the health care system. Rationalization may induce in fact hidden rationing of care and increases the workload of the health care workers involved. The relation of hospital staffing to inpatient quality of care are important issues. The reduction of funds may place patients at risk, due to lower staffing levels. Patient to nurses ratio have a substantial effect on inpatient mortality and nurse burnout. Research in Switzerland is needed to define the measurement of the nursing case mix on the basis of discharge data and to elucidate the factors influencing the staffing levels of nurses and the mix of nursing personnel in hospitals. Due to reduced funding the ability of hospitals to handle emergency cases may be compromised. The impact on quality and risks of unreflected cost minimization programs in hospitals but also the whole health care system are important and worth of public notice. Possible solutions for a health care reform in Switzerland are outlined and discussed.