COVID-19 opened the door to major healthcare reform—but old systems and social norms still held much of the power.
During the COVID-19 pandemic, healthcare systems around the world were pushed to the limit. In Switzerland, this sparked strong public support for nursing staff and even led to a popular vote backing major improvements to nursing care. With political will, public awareness, and a clear workforce crisis, it looked like the perfect moment for real change. But did that happen?
In a recent article published in Policy & Politics, Lisa Asticher investigates how institutional legacies—particularly those tied to economic liberalisation and gender inequality—shaped the reforms that followed. The findings are both fascinating and sobering.
A crisis opens a window for change…
The pandemic created what policy scholars call a “window of opportunity”—a rare moment when governments are pushed to act fast and the public is unusually open to change. In Switzerland, the crisis spotlighted the long-standing shortage of healthcare workers. For a brief period, the federal government took on a central role, bypassing the country’s usual decentralised, consensus-based politics. It introduced emergency measures to boost staffing, target working conditions, and reorganise health services.
This seemed to mark a clear departure from Switzerland’s usual market-led approach to healthcare. Financial support was provided, childcare was offered to healthcare staff, and retired professionals were called back to work.
…but the window closes fast
Once the immediate crisis passed, however, old habits returned. The government stepped back from direct involvement, reverting to financial incentives and leaving much of the decision-making to cantonal authorities and healthcare institutions. While new policies were introduced—particularly around training and recruitment—bolder measures, like improving working conditions and pay, remained piecemeal, this despite the popular vote to strengthen nursing care.
Why? The article finds two major forces at play. First, Switzerland’s liberalised health system is structured around cost control, making it difficult to justify reforms that might increase staffing costs. Second, the predominantly female nursing workforce remains undervalued—seen as a caring profession rather than one needing professional development and leadership opportunities.
Education, yes. Workplace reform, not so much.
The most significant policy changes took place in education. Training programmes were expanded and better funded, and nurses gained some new professional rights, like being able to bill directly for certain services. But broader reforms—such as pay increases, improved working conditions or leadership pathways—remained limited.
While the pandemic had created momentum for change, the reforms that followed were shaped more by existing political and economic structures than by new ideas. In short, Switzerland took the path of least resistance: invest in education, avoid confrontation over workplace change.
What does this mean for policy makers?
This research is a reminder that even when crisis creates opportunities for reform, deep-rooted institutional norms still shape what gets done. If healthcare systems are to become more equitable, sustainable and resilient, then governments must not only act in a crisis—but also challenge the social and economic legacies that hold change back.
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You can read the original research in Policy & Politics at
Asticher, L. (2025). How institutional legacies constrain reform during a favourable policy window: COVID-19 and the healthcare workforce shortage. Policy & Politics (published online ahead of print 2025), available from: < https://doi.org/10.1332/03055736Y2025D000000067>
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