Abelin Theodor
Department of Social and Preventive Medicine, University of Berne, Switzerland.
J Public Health Policy. 2006;27(4):355-65. doi: 10.1057/palgrave.jphp.3200093.
The Swiss health system results from a balance between federal and cantonal (state) legislation. Federal laws were instituted to combat infectious disease, certain other severe or widespread diseases, and alcohol and drug abuse; for the protection against harmful agents or substances; and on health and accident insurance. Cantonal implementation permits adaptation to local situations. In the case of health protection, this interplay of federal standards setting and cantonal implementation has been generally successful, but situations in the areas of immunization and breast cancer screening are presented, where, in the absence of uniform legislative guidance, cultural and political diversity has led to regionally different approaches. Varying levels of preventive action have resulted in measurable differences in mortality and morbidity. Lessons for other countries are discussed, where decentralization of preventive and health care services is being considered.
瑞士的卫生系统源于联邦立法与州（县）立法之间的平衡。制定联邦法律是为了抗击传染病、某些其他严重或广泛传播的疾病以及酒精和药物滥用；防止接触有害因子或物质；以及涉及健康和意外保险。州的实施允许根据当地情况进行调整。在卫生保护方面，联邦标准制定与州实施之间的这种相互作用总体上是成功的，但文中也介绍了免疫和乳腺癌筛查领域的情况，在缺乏统一立法指导的情况下，文化和政治多样性导致了地区性的不同做法。不同程度的预防行动导致了死亡率和发病率方面可衡量的差异。文中还讨论了对其他国家的启示，这些国家正在考虑将预防和医疗服务权力下放。
