Switzerland's Health Tech Assessment System Needs Stronger Political Support and Funding

Switzerland's approach to evaluating new medical technologies works, but it is quietly falling apart from the inside. The country maintains what looks like a functioning system for assessing health technologies—the Federal Office of Public Health coordinates structured reviews of drugs, devices, and procedures—yet the machinery lacks the funding, political will, and institutional muscle to do the job properly. A comprehensive study conducted between 2021 and 2023 reveals the gap between what Switzerland's health technology assessment system appears to be and what it actually can accomplish.

Researchers surveyed nine major organizations involved in HTA work across Switzerland and interviewed eight senior experts and leaders in the field. The picture that emerged is one of technical competence undermined by systemic neglect. Nearly all the organizations surveyed—89 percent—demonstrated a solid understanding of what health technology assessment is and why it matters. Two-thirds of them recognized the Federal Office of Public Health as the central coordinating body. But recognition and resources are not the same thing. Only 56 percent of organizations reported having substantial funding. More troubling, only 11 percent of the organizations actually measured whether their assessments influenced real healthcare decisions. The work was happening; nobody was checking if it mattered.

The scope of what gets evaluated is also narrower than it should be. Two-thirds of organizations focused their assessments on new technologies entering the market, while only 22 percent examined emerging technologies, incremental improvements to existing ones, or devices in decline. When assessments did happen, they concentrated almost exclusively on clinical effectiveness and cost—89 percent of organizations prioritized these dimensions. But safety, equity, feasibility, and what patients and communities actually think about a technology received far less attention. Social acceptability and feasibility considerations were the least commonly examined aspects across all technology types. This means Switzerland's system was answering the question of whether something works and costs money, but not whether it can actually be implemented or whether people will accept it.

The human infrastructure supporting this work is skeletal. Every single organization surveyed employed fewer than 20 professionals in their HTA units. Sixty percent had between 6 and 20 staff members; 40 percent had between 1 and 5. These small teams were drawing from public health, clinical science, law, engineering, and information technology—a genuinely multidisciplinary effort—but they were stretched thin. The Ministry of Health was the most frequent requester of assessments, followed by public healthcare providers and insurance bodies. Demand was steady. Capacity was not.

When organizations were asked what was holding them back, the answers were consistent and damning. Fifty-six percent cited lack of awareness about HTA's importance, insufficient political support, and weak institutional capacity as the main obstacles. Forty-four percent pointed to a shortage of qualified staff. Thirty-three percent said HTA was not properly institutionalized. These were not technical problems—they were structural ones. Switzerland had the knowledge but not the commitment.

What makes this particularly significant is that Switzerland's healthcare system is fragmented across 26 cantons, each with its own governance structures. The Federal Office of Public Health provides some coordination, but there is no unified national HTA agency. Organizations were using guidelines from the European Network for Health Technology Assessment and the World Health Organization, but application was inconsistent. Half the organizations reported that timelines for HTA processes were neither transparent nor binding. Appeal procedures had no clear timelines at all. Decision-making timelines did not exist in half the cases.

When asked what would strengthen the system, organizations were clear: 62.5 percent said awareness-building about HTA's value was essential, and the same proportion identified institutional strengthening as critical. Fifty percent said budget increases were fairly important. The message was not complicated. Switzerland needed to decide that health technology assessment mattered enough to fund it properly, to staff it adequately, and to integrate it into decision-making at every level. Without that commitment, the system would continue to produce technically sound assessments that nobody relied on, in organizations that nobody knew about, with staff who were perpetually overextended. The study's authors called for establishing a dedicated national HTA agency to coordinate across cantons and embed assessment into the fabric of Swiss healthcare decision-making. Until that happened, Switzerland would keep building the machinery while starving it of fuel.