The quality of clinical indications: how can we improve medical decision-making
14 September 2026 | Comment(s) |
Luca Strebel
Not everything that is medically possible is necessarily the best option for every patient. A new study conducted by the Zurich University of Applied Sciences (ZHAW) highlights why greater attention must be paid to the quality of medical decision-making.
Assessing whether a procedure was performed correctly or a medication administered according to standards is relatively straightforward. Far more challenging is answering a fundamental question: was the treatment actually the right choice for this patient?
This is precisely what “quality of indications” is all about. It refers to the appropriateness of a medical intervention for a specific individual. High-quality indications ensure that the right treatment is chosen at the right time, based on scientific evidence, the patient’s clinical situation and their personal needs. In some cases, the most appropriate decision may even be not to treat.
A study commissioned by Fondation Groupe Mutuel and carried out by the Winterthur Institute for Health Economics at the ZHAW shows that various approaches to promoting quality of indication already exist in Switzerland. However, there is a lack of a common strategy, comparable data and consistent implementation. To address these gaps, the study proposes nine courses of action.
Nine courses of action for Switzerland
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1. Further develop medical guidelines and make them more binding
Evidence-based and regularly updated guidelines provide a reliable basis for medical decisions. Their binding nature can be strengthened, for example, through independent reviews, without restricting the necessary clinical discretion of doctors. -
2. Strengthen quality development within organisations
Medical boards, quality circles and peer reviews make it possible to jointly review decisions on indications. Structured data and comparisons between hospitals or specialist departments can highlight anomalies and trigger targeted improvements. -
3. Further individualise treatment pathways
Data on the quality of indications and outcomes can help to better assess risks prior to a procedure and tailor treatment to the individual. Digital or AI-supported decision-making tools may also play a role in this regard in future. -
4. Better coordinate patient pathways
General practitioners (GPs), specialists, hospitals and other healthcare professionals need access to the relevant information. Improved information sharing facilitates the joint assessment of indications and can prevent duplicate investigations or conflicting treatments. -
5. Strengthen patients’ shared responsibility
Patients should understand the benefits, risks and alternatives of a treatment and be able to participate in decision-making. Clear information, health portals and second-opinion procedures enhance health literacy and shared decision-making. -
6. Make the effectiveness, appropriateness and cost-effectiveness review more effective
Structured data on the quality of indications can improve the assessment of effectiveness, appropriateness and cost-effectiveness. This could provide health insurers with further opportunities to identify unusual treatment patterns and investigate them together with the relevant healthcare providers. -
7. Select healthcare providers on the basis of quality
When selecting healthcare providers, information on the quality of indications should be taken into account alongside cost-effectiveness and treatment outcomes. This applies in particular to alternative insurance models: under these models, insured persons, in return for a lower premium, first seek advice or treatment from a specific point of contact, such as a GP practice, a network of doctors or a telemedicine centre. In future, such models could refer patients more specifically to healthcare providers who have a proven track record of making high-quality medical decisions. Greater consideration could also be given to the quality of indications in cantonal hospital planning. -
8. Align remuneration more closely with quality
Remuneration should not be based solely on the volume of services provided. Models could be envisaged that take into account guideline-compliant treatment decisions, the avoidance of unnecessary procedures and long-term treatment outcomes, in line with VBHC approaches such as Pay4Quality (P4Q). -
9. Develop new insurance products
New insurance models could combine several of these approaches. Possible features include preferential access to proven service providers, quality-oriented remuneration (P4Q approaches), second opinions and digital decision-making aids. The focus must be on better, evidence-based and patient-centred care.
Quality over quantity
Improving the quality of clinical indications is first and foremost a quality initiative, not a short-term cost-cutting programme. However, avoiding unnecessary or inappropriate treatments can also reduce risks and preventable costs.
Switzerland does not have to start from scratch in this regard. Initiatives such as “Smarter Medicine”, tumour boards, quality circles and registers such as SIRIS provide a sound foundation. The task now is to combine these approaches and develop them further step by step. Good medicine is not about doing as much as possible, but about doing the right thing for every patient.
