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Founded in Geneva in 1996 under the auspices of the Council of Europe, FEDRE has always focused on cross-border regions. In 2023, it formed a partnership with Crédit Agricole next bank to study the border effect along Switzerland’s periphery in various fields, some of which go unnoticed by the general public. Following Issue 1, which addressed food aid, this second issue examines the challenges facing the healthcare sector in certain border areas of Switzerland, which are losing some of their healthcare staff drawn to higher salaries and better working conditions.
Why has the healthcare system fallen into disrepair in Haute-Savoie and the Pays-de-Gex? In Haute-Savoie, it must be said that the sector has not been doing well for a number of years. Compounding this is the negative impact of the region’s proximity to Geneva, which draws away healthcare staff due to its attractive salaries and working conditions. For its part, the Pays-de-Gex is becoming a medical desert, as the outdated model of the “family doctor” has persisted there for too long, when the focus should have been on establishing multidisciplinary medical practices—the only ones capable of ensuring the next generation of care by attracting young doctors who work as a team.
Mental health severely affected
The mental health sector has been in decline for many years in Haute-Savoie. The Thonon facility closed and was relocated to La Roche-sur-Foron, where 100 beds—half of the total—had to be shut down. If the situation worsens, this would raise obvious public safety concerns, officials worry! However, many healthcare workers are also leaving due to the hospital’s disorganization, and the Belle-Idée psychiatric unit in Geneva is attractive not only for the compensation it offers but also for the quality of its patient care.
In Savoie, on the other hand, the psychiatric hospital in Bassens appears to be better organized, and overall, the Departmental Council has played an active and positive role.
Overall, the issue has not been addressed politically because the state, the department, and the intermunicipal communities tend to pass the buck to one another.
Sharing experiences to find solutions
The same observation can be made in other fields, such as oncology. And between cross-border regions as well, sharing experiences is important for developing a comprehensive perspective.
Looking at the bigger picture, it becomes clear that while competitive salaries play a crucial role, they are not the only factor to consider. There is also the number of positions available and the number of patients to care for, as well as working conditions, which depend on the number of patients a caregiver must handle—a figure that is nearly three times higher in neighboring France than in Geneva.
While the HUG and Geneva’s private clinics claim to exercise a degree of restraint in hiring—despite their needs—by referring to quotas, the percentage of cross-border workers remains enormous, accounting for more than half of the medical staff overall. Many healthcare workers are recruited by private staffing agencies that do not care about this issue. And on the French side, when beds must be closed because well-trained staff are crossing the border, care is not provided, leading to lost revenue and underutilization of existing equipment. Other border regions in Switzerland are facing the same type of problems.
In Lombardy, which borders Ticino, discussions have been underway for several years now regarding the creation of a bonus for healthcare workers, funded by a special fund, which would increase their salaries by about 20%. But this falls far short of what is needed, as salaries would have to be doubled for the scheme to be attractive.
Such a system is effective only in the neighboring German region of Basel, where it is implemented, because the wage gap is smaller there. Elsewhere—whether in Geneva, Ticino, or the Jura Arc—the appropriate response is rather to develop, over the medium term, sufficienttrainingefforts for healthcare staff on the Swiss side, and to stop relying on such a large number of cross-border workers to staff the sector. This also involves promoting these professions in ways that go beyond financial incentives, as Swiss salaries are not unreasonable when one considers the social value of these professions! Training for healthcare staff should be at the heart of upcoming cross-border cooperation meetings, as the same measures must be taken on both sides.
Geneva’s overwhelming appeal
This is the most challenging cross-border issue. There is no need to place blame on individuals or public or private companies; rather, we must expect all stakeholders to recognize the consequences of this worsening situation, which has been ongoing for years and has caused significant regional instability in the healthcare sector.
It’s time to tackle the problem head-on.