Treatment of a disease occurs within a system, and healthcare systems around the world vary greatly depending on culture, economic status, and resources. These differences become evident to those who have either been a patient or practitioner in a foreign healthcare system and a lot can be learned about what truly constitutes excellent healthcare when one reflects upon these differences. After completing my neurology residency in the U.S., I had the opportunity to spend a fellowship year at the University Hospital in Basel, Switzerland which has one of the largest and most renowned MS clinics in the region. Although both the U.S. and Switzerland are developed countries that are economically well off, the healthcare systems are very different, and this has a large impact on how MS patients receive care.
There are many things the Swiss do well, which I found to be lacking in the U.S. healthcare system upon my return. MS patients in Switzerland can receive physical therapy year round, hippotherapy (riding horses) for treatment of spasticity, or stay for a month in a MSdedicated neurorehabilitation facility in the Swiss alps (not just after a relapse, but also for general improvement in conditioning).