Publication Date
Fall 2025
Abstract
Rising healthcare costs in Switzerland—driven in part by incentives that reward service volume over value—have sparked interest in alternative payment models such as Pay-for-Performance (P4P). Yet Switzerland remains in the early stages of experimenting with P4P, making this a timely moment to examine how the country’s health system structure shapes the design, implementation, and feasibility of such reforms. This study investigates two gaps in the existing literature: the largely unexamined role of health system typology in conditioning P4P outcomes, and the limited understanding of how Switzerland’s Bismarckian model influences P4P adoption. Using a mixed-methods qualitative design, the study combines a comparative analysis of P4P initiatives in Beveridge, American, and Bismarckian systems with a Swiss case study informed by seven expert interviews. Guided by the WHO health system building blocks, the analysis identifies structural determinants (i.e., governance fragmentation, financing misalignment, sectoral silos in service delivery, physician autonomy norms, and weak information infrastructure) that collectively constrain P4P in Switzerland. It then outlines the implementation requirements necessary for meaningful scale, including legal reforms, cross-sectoral financing alignment, collaborative incentive design, workforce training, and interoperable ICT systems. Ultimately, the study argues that Switzerland’s typology both limits and enables P4P, and that recognizing these structural realities is essential for designing value-based reforms capable of improving quality while containing costs.
Disciplines
Medicine and Health Sciences | Social and Behavioral Sciences
Recommended Citation
Zhang, Joyce, "Structural Determinants of Pay-for-Performance: Cross-System Analyses and Implications for Switzerland's Bismarckian Model" (2025). Switzerland: Global Health and Development Policy. 11.
https://digitalcollections.sit.edu/szh2/11