Too many hospitals? Expert sees no future for Zurich's rural hospitals

For health economist Heinz Locher, Zurich's rural hospitals are relics from the old days that no longer have any justification: There is no need for any more hospitals between Zurich and Rapperswil.

Wetzikon Hospital is up to its neck in water. It has debts of 170 million Swiss francs and a new building that it cannot complete for the time being. Today it presented a restructuring plan that requires creditors to waive two thirds of their claims on the health center.

Health economist Heinz Locher recommends merging the Wetzikon and Uster hospitals immediately. A few years ago, he oversaw the merger of the Zurich hospitals in Bauma, Wald and Rüti with the one in Wetzikon and knows his way around the Swiss hospital landscape.

In an interview with the Tages-Anzeiger newspaper, he proposes a radical downsizing. He is convinced that Zurich's healthcare system could be restructured in ten years' time. The prerequisite is that the canton of Zurich begins the reorganization immediately.

The merger of the Uster and Wetzikon hospitals has been discussed for years, sometimes pushed forward and then put on hold again. Locher would carry it out immediately and put pressure on them to do so: Health Director Nathalie Rickli could withhold all current orders until the two hospitals gave her a binding indication of how they will work together from 2025.

Zero instead of three hospitals in the Zurich Oberland

According to the healthcare economist, this merged hospital is not needed in the longer term either. His thesis is that there will no longer be a need for a hospital between Zurich and Rapperswil (SG).

This would also wipe Männedorf Hospital on Lake Zurich off the map. Of the current three hospitals in the Zurich Oberland, none would remain. Locher recommends converting the closed hospitals into health centers. These would have "walk-in emergency wards" and doctors' surgeries - but no large wards as before. No major operations would be carried out there either.

He does not accept that the Zurich Oberland would no longer have a quickly accessible emergency room. The decisive factor, he says, is that the ambulance service can reach people who need medical help quickly. The highly trained paramedics would stabilize the person and decide where to take them.

Emergency care will not suffer

Whether the nearest emergency station is ten minutes' drive away is irrelevant for patient care. What is important, however, is that the remaining hospitals in Zurich and Rapperswil SG each have a large outpatient clinic. For people in the northern Zurich Oberland, the cantonal hospital in Winterthur may also be the closest.

According to Heinz Locher, it is also reasonable to travel twenty minutes longer than before for planned operations. The advantage is that the artificial hip joint, for example, is implanted by a team that does this 300 times a year and not just 25 times. He is convinced that concentrating healthcare provision in fewer locations would increase its quality.

In an interview with the Tages-Anzeiger newspaper, Locher does not offer a solution to the shortage of GPs. He points to existing services such as nursing specialists who offer certain treatments in pharmacies and can consult a doctor on screen if necessary.

The expert also hopes that more procedures will be carried out on an outpatient basis if there are fewer beds available or they are further away. This would also eliminate night shifts and make the nursing profession more attractive.

Economist: concentration increases quality

Locher also knows how Nathalie Rickli can sell the closure of hospitals to the population: The government councillor would have to convince them that emergency care would improve and that there would be no shortage of hospital capacity.

The reason why many people are attached to the small hospital close to them is precisely because of this small distance and manageability. Locher has no substitute for this.

For him, it is clear that the many regional hospitals cannot be financed in the long term. Hospital policy is still being pursued as hospital construction policy. Those responsible would consider how they could fill their hospitals. Instead, the canton should clarify which medical services it wants to provide and where.