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November 21, 2009The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World – Part 10 – Switzerland
In the midst of our national debate about healthcare reform, people on both sides of the debate seem to pick and choose among the facts and myths about the nationalized healthcare available in a number of other countries. The fact is that every nationalized health care system in the world is battling issues of rapidly rising costs and decreasing access to care. But, these systems also have some very attractive benefits. So, in this last blog of this 10-part series, let’s take a look at the pro’s and con’s of the Swiss system.
Michael Tanner, the director of health and welfare studies at the Cato Institute, is the coauthor of Healthy Competition: What’s Holding Back Health Care and How to Free It and the author of this series:
I have already written about Switzerland in previous posts (see Swiss Healthcare Sytem: Part I, and Part II). Still of all the countries with universal health care, Switzerland’s is the most market-oriented and merits discussion. Switzerland’s health care spending as a percentage of GDP is second only behind the U.S. (11.6% of GDP for Switzerland, 15.3% for the U.S. according to Frontline), yet the government pays for very little of this funding. The Swiss system is similar to the “managed competition” health care plan proposed by the Clintons in the early 1990s.
Percent Insured. 99.5%. Does this mean a mandated system system would lead to universal coverage in the U.S? This is unlikely. In Switzerland, a mandate for auto insurance has nearly 100% compliance, but in the U.S. the auto insurance mandate’s compliance rate is only around 83%.
Funding. Insurance is purchased by individuals. Individuals generally must pay the full cost of premiums, but the government helps to finance insurance purchases for the poor. “These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance,” and one third of Swiss citizens receive this type of subsidy. Thus, the Swiss government only pays for 24.9% of health care costs (compared with 44.7% in the U.S.).
Private Insurance. All insurance is private insurance. However, insurance companies are mandated to offer the same “basic benefits package.” Some physicians operate outside the negotiated schedules and individuals are beginning to purchase supplemental insurance to cover the cost of these higher cost physicians. Some estimates claim that 40% of Swiss citizens have purchased supplemental insurance.
Physician Compensation. Physician compensation is negotiated between the insurance companies and doctors on a canton by canton basis. Balance-billing is not allowed. Switzerland has strong regulation with respect to nonphysician health care professionals (e.g., nurses, PAs, NPs,) and thus patients are often compelled to use expensive physicians even when this may not be medically necessary.
Physician Choice. According to a WHO study, Switzerland ranks second only to the U.S. in terms of the ability of patients to choose their provider.
Copayment/Deductibles. Premiums are community rated and only adjusted for sex and age. Employers do not pay for workers insurance and thus many Swiss have opted for less expensive plans with higher deductibles. This has lead to the Swiss paying for 31.5% through out of pocket expenses.
Waiting Times. According to a WHO study, Switzerland ranks second only to the U.S. in terms of timely care.
Benefits Covered. All insurers cover the “basic benefits package” so most competition between insurers is based on price and service. A politically defined benefit package is susceptible to influence from special interest groups. Thus, Uwe Reinhardt notes that “over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven aspects of the Swiss system.”
I hope this series has been helpful to you.
Here are links to the entire series: The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World
