Health services research is an applied field of science that focuses on the care of both sick and healthy individuals. It was founded in the 1960s by John Wennberg at Dartmouth College (USA) and has a long tradition in the USA, the United Kingdom, and Scandinavia. It addresses three levels:

• At the micro level, health services research focuses on the interactions between individual service providers and patients.
• At the meso level, the focus is on institutional service providers, the organization and delivery of health services and medical care, as well as the assessment of service performance in terms of quality, effectiveness, or appropriateness.
• At the macro level, the health system is the central focus (health system research). For example, legal and health policy issues, as well as questions related to financing and health data, are addressed.

Health services research provides solid scientific foundations and analyses for the management and development of the healthcare system, ultimately aiming for better care for people in Switzerland. Decision-makers in the Swiss healthcare system rely on the results of this research to make evidence-informed decisions. This helps to prepare the healthcare system for challenges and to ensure access to healthcare for all population groups.

Swiss healthcare research has been and continues to be specifically promoted by various institutions and initiatives:

• From 2012 to 2016, the Swiss Academy of Medical Sciences SAMS and the Gottfried and Julia Bangerter-Rhyner Foundation conducted the "Healthcare Research in the Healthcare System" funding program.
• From 2016 to 2021, the Swiss Cancer Research Foundation, with the support of the Accentus Foundation (Marlies Engeler Fund), implemented a research program embedded in the National Strategy against Cancer 2014-2020, which financed studies on healthcare research in oncology.
• With the launch of the National Research Programme NRP 74 "Healthcare" 2017-2022, the Federal Council sent a clear signal to strengthen healthcare research in Switzerland.
• Since 2017 until the end of 2024, the Swiss Learning Health System SLHS, supported by swissuniversities, has been developing evidence-informed solutions for the healthcare system through dialogue between various stakeholders in the healthcare sector.
• The Swiss School of Public Health SSPH+ promotes the doctoral level through interuniversity teaching offerings (Interuniversity Graduate Campus) as well as postgraduate training programs. It supports the expansion of large cohort studies such as the Citizencohort and Corona Immunitas. Additionally, it promotes knowledge transfer through targeted Science-to-Policy activities. Since 2024, it has been the umbrella for Smarter Health Care.
• Switzerland participates in the Horizon Europe 2021-2027 program on Transforming Health Care Systems THCS and the Eureka project CH-NL "Research and Development in ehealth and health," enabling Swiss researchers to access these funding instruments.

Smarter Health Care advocates for the increased use of routine data, such as billing data from health insurance companies or information from electronic patient records, in health services research to gain insights into the quality, effectiveness, and economic efficiency of care.

The use of this data for health services research is currently limited in Switzerland because it is stored in isolated, inconsistent data silos. Additionally, differing data collection, transport, storage, and validation processes complicate the linkage and analysis of this data. Furthermore, data processing for research purposes is regulated by various laws, such as the Federal Act on Research involving Human Beings HRA and the Federal Act of Data Portection FADP, as well as cantonal data protection laws. This leads to often complicated and lengthy approval processes with many uncertainties for research projects.

Countries such as Denmark and the United Kingdom have established efficient legal and technical structures for the use of routine data. Various initiatives aim for similar improvements in Switzerland:

• DigiSanté is the program of the Federal Department of Home Affairs FDHA to promote the digital transformation in healthcare. It is being developed on behalf of the Federal Council and is being formulated by the Federal Office of Public Health FOPH and the Federal Statistical Office FSO in an initialization phase until the end of 2024, and will be implemented until the end of 2034.
• Inpatient medical sector: The Swiss Personalized Health Netzwerk SPHN, the Modules Ambulatoires des Relevés sur la Santé MARS, and the eHealth Schweiz 2.0 strategy as an overarching framework.
• Outpatient sector: Regional initiatives such as the FIRE project.
• Political initiatives: The Postulat Humbel 15.4225 “Better use of health data for high-quality and efficient healthcare” and the motion 21.3021 of the National Council’s Science Committee “Added value for research and society through data-based ecosystems in healthcare.”
• Research programs: Synthesis report on health data from the NRP 74 in Switzerland, highlighting key requirements for the better use of routine data.
• Data portals: opendata.swiss is the central portal for open, i.e., freely accessible data from Swiss authorities (Open Government Data, OGD). The I14Y Interoperability platform is the National Data Catalog of Switzerland, supporting efficient data exchange between authorities, businesses, and citizens.