THE SWISS HEALTHCARE SYSTEM

By: Rafael Rodriguez

Agenda

I.) Overview of the Systema)Definitionsb)Introduction to Swiss HealthCare System

II.)Health Care Packagesa)What is Offered?b)Insurance Policies c) Types of Care

III.) Issues with the Carea)Pros and Cons

IV.) Summationa) Is the Swiss System a well-working system?

I. Overview of Swiss Health Care System: Definitions

• The aim of the HiT initiative is to provide relevant comparative information.

HealthCare Systems in

Transition (Hit)

• Compiles current, detailed, and comparable data on healthcare systems.

• To support policy-makers and analysts in the development of HealthCare systems in countries of Europe and beyond.

Responsibilities:

Cont. Definitions

• The WHO provides counseling on issues detrimental to health and meditating the creation of partnerships.

WHO = World Heath

Organization

• Providing research data that is used to create or modify standards of policies. The research is based off of ethical and evidential reasoning.

• Uses technical support, develops sustainable institutions, and assesses the health situations of each country by delivering a comprehensive analysis of newly-changing health trends.

Responsibilities:

Cont. Definitions

• To promote policies that will improve the economic and social well-being of people around the world.

OECD = Organization for

Economic Co-operation and Development

• OECD collaborates with governments to understand what creates economic, social and environmental change.

• Measures productivity and global flows of trade and investment.

• Analysis of data with comparisons that predict future trends in which they set international standards on a wide range of things, from agriculture and tax to the safety of chemicals.

Responsibilities:

I. Intro to the Swiss HealthCare System

• Canton – Member states of the Swiss Federation with each of their own constitutions and governments but are not limited to the power of the Swiss Federal Constitution.

• At an institutional level, the cantons and municipalities were almost exclusively responsible for health and welfare.

Quick Bio: Switzerland

known as the “Swiss

Confederation.”

Cont. Swiss Health Care System

• Came into effect in 1996 under the Health Insurance Law named (LAMal).

• LAMal stands for the Swiss Federal Law on Compulsory Health Care. LAMal was created on March 18th, 1994.

• The goal of this law: perfect managed competition with full coverage in basic health insurance.

Switzerland’s current Health Care System.

II. Health Care Packages

Basic Package – Individuals can

only seek treatment in

their canton of residency.

The Basic Package has

three categories:

Cont. Health Care PackagesExamples of Coverage include:Hospital stay and outpatient care in any general ward of the canton

of residency; Nursing care, of up to 60 hours per week at home or in a nursing

home; Examination, treatment and nursing in a patient’s home by a

physician or chiropractor; Rehabilitation ordered by a physician, including health resorts;

Emergency treatment abroad; Transportation and rescue costs (50% of emergency transport costs up to CHF 5,000 per year and 50% of non-life threatening transport up

to CHF 500 per year);Legal abortion; Maternity costs, including 7 routine examinations, post-natal

examination, childbirth and 3 breast-feeding consultations; Serious and inevitable dental

treatment;

Source : Citivas.org.uk

HC Pkges: Universal Coverage

Universal Coverage: An essential add-on that guarantees that “vulnerable groups” get the treatment needed.

All individuals must purchase a basic package insurance plan or face a penalty. (A large fine)

Insurers must charge the same price to every individual that buys a particular health care plan: in other words they cannot vary premiums based on the health status of each consumer.

Cont: Universal Coverage

To make sure insurers follow the rules Foundation 18 was created.

Foundation 18 is a risk equalization solidarity that reallocates funds from the health plans with lower percentage of risk to those with a higher percentage of risk. It is determined by age and

gender of the enrolled.

Individual cantons provide tax and means subsides as a form of financial-aid.

According to the Federal Office of Public Health (FOPH) 30.5 per cent of insured individuals

required this financial assistance in 2009.16 Source: citivias.org.uk

Cont: Universal Coverage

Federal Office of Social Insurance: Governs insurance companies actions.

Choice of Insurer and Health Care Funding: Insurers are required to register with FOSI to comply with the monitoring of insurance companies by the government.

This system allows individuals to choose from 80 to 90 different plans. Consumers also have the choice of switching their insurance provider up to two times per year.

UC: Private Insurance Companies

Premiums – Since companies are allowed to compete on price-there is a differing cost of health insurance within and between each of the Cantons.

An example of this : “In 2001 premiums ranged from $119 per month for high-deductibles, to $159 for a managed care plan and $199 per month for low-deductibles. However, in 2005 it was found that the difference between the lowest and highest premiums with a 300 CHF deductible was 89% in the Zurich area. This suggests that factors other than deductibles are affecting the price of plans and many believe that it is in fact predominantly the result of a poor risk equalization system” (Source: civitas.org.uk)

Cont. UC: Pvt. Insurance Comp.Deductibles – A form of payment to avoid moral

hazard and to allow treatments to be covered by the insurance. (Think of it as a fee that must

be paid to continue coverage) Depending on the insurer, deductibles

vary.

Individuals who opt for higher deductibles pay

lower flat-rate premiums.“To safeguard solidarity (Foundation 18) the

scheme is regulated by the Federal government, which sets a minimum

and maximum deductible of 300 CHF

($325.44) and 2,500 CHF ($2712) respectively;

(for children these figures are 100 CHF ($109) and 600 CHF

($651).”

“Costs exceeding the deductible are paid for by the insurer. Patients still have to pay 10% of the remaining balance

known as the co-payment. To prevent

outrageous costs this co-payment is capped at

CHF 700 ($759) per year by cantons”

(Source: civitias.org.uk)

Cont. UC: Pvt. Insurance Comp.

No-claims bonus scheme: A rule that discourages overuse of services. Individuals that do not submit claims receive an increasing reduction in their premiums each year.

After 5 years this can reach as much as 45% - a clear incentive to adopt healthier lifestyles.

UC: Supplementary Insurance

Supplementary Insurance: A voluntary health care

package that includes more options than the basic

package.Examples of this :

Most dental care; The freedom to choose

any hospital for ‘basic’ treatment;

Ensuring increased comfort and privacy during treatment; such as “private”, a one-bed

room; Guarantees of receiving treatment from the

most senior physicians.

A non-smoker package, which offers savings of up to 20%.

Since its introduction in 1995, this option has attracted

about 30% of that particular insurer’s new members

(Source: civitas.org.uk)

UC: Primary, Secondary, and Tertiary Care

III. Issues with Swiss Health Care System: Pros of Swiss HC System

There is no fixed cap on Health Care spending

Incentives for policies lead individuals to be

cost-effective the premium benefits

Providers are constantly improving policies and plans to

meet the needs of the individuals.

Cons of Swiss HC System

Affordability : Basic Package premiums have increased by an avg. 5% per year and out-of-pocket expenditure is high.

Out-of-pocket expenditure accounts for 30.5 per cent of total health expenditure in Switzerland.

Cont. Issues w/ Swiss HC system

Comprehensiveness of Basic Package: The BP has so many benefits that are being added, which results in increased costs for everyone.

Proposed Solutions: Shifting some of the lower-end treatments to the supplementary insurance coverage. Since there is a competitive market, the reform would have to guarantee that those with chronic diseases will treated since it would no longer be in the basic package.

Summation

Question: Is the Swiss System a well working system?

The Swiss have universal health care while preventing large regional health gaps. Ensuring that individuals have access to top-notch and

high-quality medical services.

Keep in mind Switzerland is generally a wealthy country.

Although rising costs are a concern, they could legitimately argue on the basis of their outcomes,

that they are getting value for money.

The individuals get to choose the Health Insurance Plan along with the choice of Health

Providers.

What do you think?