however costeffectiveness is not systematically assessed according to a welldefined and rigorous methodology and the decisionmaking process lacks transparency as financial pressures from the health system increase ensuring that investment is driven by evidence on costeffectiveness would be worthwhile at a time when switzerland will need to rely increasingly on primary care personnel to coordinate and support patients living with chronic disease the number of general practitioners has been declining relative to specialists and there are substantial differences across cantons the swiss medical and nursing workforce is ageing and a significant number are expected to retire in the next two decades