After the United States Switzerland provides the second most expensive health care system worldwide. Likewise in all other industrialized countries, there is an intensive debate about cost containment. In general care several models are under evaluation not only to reduce costs but also to improve quality of treatment and care in highly fragmented health care systems. These models deal with primary care providers as gate keepers or managed care. There is also a discussion about the introduction of DRGs in inpatient treatment.

There is not a comparable development at present in mental health care. There are few case management models tested, trying to integrate and coordinate a multitude of institutions involved in the treatment and care of chronically mentally ill. The most progressive trial is under consideration at the University of Zurich, where patients after admission to inpatient treatment immediately are referred either to continuing inpatient treatment or to acute day-hospital treatment or to outpatient treatment. This model is the closest on the way to a patient-centered model of treatment in care while the above mentioned models all try to deal with the disadvantages of fragmented institutional care systems.