Realized by mandate of the Swiss Health Observatory this study conducts a forecast of the costs generated by medico-social establishments (EMS) and services of assistance and care in residence (SASD) by 2030. Its goal is to highlight the pressures exerted on the system of care long lasted (SLD) by the evolution of:

• demography; 
• morbidity; 
• costs by patient. 

The study examines their impact on the costs and the requirements in future care within an institutional and social framework presumedly unchanged In particular, the characteristics of the system of SLD  –system of financing and structure of the offer  –is supposed to be unchanged because they are not factors of pressure, but of the elements on which the authorities can act to adapt and direct the system. 

Scenarios

Uncertainties as for the evolution of demography, morbidity and the costs by case are significant, this is why the forecast considers various scenarios. The first constitutes the scenario of reference with which to compare the other alternatives; it draws the trend of costs on the assumption that the current tendencies are prolonged. In manner detailed, the assumptions retained in the scenario of reference postulate that: 

• the Swiss population will evolve/move according to the demographic scenario "tendency" (OFS); 
• the individuals will resort to the EMS/SASD at the same ages as today; 
• the costs of the medical benefits will increase at the same rate/rhythm as in the past; 
• the costs of the socio-hotel services and family help will evolve/move at the same rate/rhythm as the productivity 

The other scenarios examine, for each parameter successively, the assumption of an evolution different from that postulated in the scenario of reference:  

• scenario 2 examines the effect of an ageing accentuated or attenuated population 
• scenario 3 shows the impact on the request and the costs of a shift in the age of appearance of the functional disorders;
• scenario 4 finally simulates the evolution of the expenditure by supposing an increase in the medical unit costs slower than in the scenario of reference.