Articles: Circular Economy in Medicine

Source: Synapse, Ärztegesellschaft Basel-Land, https://synapse-online.ch/wp-content/uploads/2024/12/Synapse_6_2024_150dpi.pdf, December 2024.

The article, "Circular Economy Instead of Waste Management in Medicine," addresses the growing reliance on single-use medical products in the Swiss healthcare system, arguing that it creates a massive environmental burden and unnecessary financial costs without providing a proven benefit in patient safety. It critiques rigid, bureaucratic hygiene regulations and perverse financial incentives (tariff structures) that drive the "single-use boom," advocating instead for a systemic transition to a resource-efficient circular economy focused on reuse, reprocessing, and transparency.

The Problem: Ecological and Economic Costs of Disposable Products

• The healthcare sector is an emissions-intensive industry, responsible for approximately 5.9% of Switzerland's total emissions.

• The widespread shift toward single-use (disposable) materials is a major contributor to this environmental footprint, significantly increasing resource consumption and greenhouse gas emissions.

• The CO₂ footprint of single-use items can be drastically higher; for instance, a cataract surgery using disposables resulted in 182 kg of CO₂ emissions, compared to just 6 kg when reusable instruments were used. In general, the ecobalance of single-use instruments is about 10 times worse than reusable alternatives.

• Current hygiene regulations, originally intended to mitigate rare risks (like prion diseases), have led to an unnecessary single-use boom that creates ecological and economic costs exceeding the benefit of any expected safety gains.

• Financial disincentives exist in the Swiss tariff system, which makes the cost of single-use items directly reimbursable, while the cost of reprocessing reusable alternatives is often uncompensated or inadequately covered in flat fees, promoting the environmentally damaging option.

• Overly rigid regulations also make it difficult for primary care practices to perform reprocessing, forcing them to purchase new disposables and increasing reliance on global supply chains, which threatens security of supply.

Solutions and Recommendations for a Circular Transition

• Implement rational Cost-Benefit Analysis for Regulations: Every new regulation must demonstrate a proven effect on risk reduction, and its implementation must be subject to a cost-benefit analysis that includes external costs, such as greenhouse gas emissions.

• Prioritize Reuse and Reprocessing: Reusing and reprocessing medical devices and textiles is measurable evidence-based practice that can reduce both costs and emissions, for example, switching to reusable sharps containers reduced emissions by 83.9%.

• Promote CO₂ Transparency: The CO₂ footprint of medical products should be transparently declared to enable healthcare providers to make environmentally conscious choices.

• Adjust Tariff Structures: Reform is needed (e.g., via the TARDOC system) to eliminate financial incentives for disposables and ensure that the efforts and costs of reprocessing reusable products are adequately and visibly reimbursed.

• Introduce Flexible, Risk-Based Standards: Hygiene regulations should be adapted to the size and equipment of the healthcare facility (e.g., separate, practical standards for a small doctor's office versus a large hospital) to avoid unnecessary resource consumption.

• Address Medication Waste: Regulations that consider the act of dispensing partial medication packages as "manufacturing" should be eliminated to allow for the targeted, correct-quantity dispensing of prescriptions, which is vital in times of drug shortages.

Source: Synapse, Ärztegesellschaft Basel-Land, https://synapse-online.ch/wp-content/uploads/2024/12/Synapse_6_2024_150dpi.pdf, December 2024.