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The Swiss Health Care System

Learn about the highly decentralized Swiss healthcare system, with cantons responsible for medical care provision. Discover the benefits of regulated competition in health insurance and the comprehensive benefits package available to all residents.

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The Swiss Health Care System

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  1. The Swiss Health Care System Robert E. Leu University of Bern November 2008

  2. The Swiss system in a nutshell • Highly decentralized (26 cantons/states) • Federal government acts mainly as regulator (Federal Health Insurance Law) and supervisor • Cantons are responsible for the provision of medical care • High physician and bed density with large regional variation • Wide availability of up-to-date medical services in high quality

  3. The Swiss system in a nutshell • Good performance with respect to outcome indicators (life expectancy, etc.) • Good performance with respect to equity criteria (health and health care utilization by income) • High patient satisfaction • Relatively high overall cost

  4. Regulatedcompetition in thehealthinsurancemarket • Health insurance as individual mandate, independent of employment • Universal coverage for all residents (# of uninsured < 1‰). • Comprehensive benefit package • Free choice between insurance companies and contract options • Free choice of physician and direct access to specialists in canton of residence (except for managed care plans) • Free choice of hospital (with regulatory limits)

  5. Regulatedcompetition in thehealthinsurancemarket • Competing, predominantly private not-for-profit insurance companies • Open enrollment subject to timing rules • Community rated premiums • Insurers set premiums to cover costs; tight control by the Swiss Federal Office of Health • Premium subsidies for lower income families • Risk equalization scheme

  6. Costsharing • Variable deductible ($ 272, $ 454, $ 907, $ 1361, $ 1815, $ 2269) with corresponding premium reduction ($ 145 to $ 1597) • Coinsurance rate of 10%, after insurance kicks in, up to stop loss amount of $ 600 • Coinsurance rate for original drugs 20% if generics are available and physician does not insist on original drug • Coinsurance is replaced by a fixed amount of $ 9 per day for inpatient care • Managed care plans may offer contracts without cost sharing

  7. Costsharing • Available studies indicate that higher deductibles reduce utilization (moral hazard) by between 15% and 50% • Self-selection accounts for 50% to 85% (deductible can be changed every year)

  8. Main Problems • Governance (fragmentation of responsibilities, multifunctional role of cantons) • Inefficient regulation (limited selective contracting, etc.) • Cantons too small as health regions • Quality monitoring on national level (benchmarking) • Incentives for disease management

  9. Lessons for other countries • Regulated competition in health insurance • Health insurance as individual mandate • Achieving high insurance coverage • Cost sharing with no negative effect on access • Premium subsidies • Decentralized approach: advantages and disadvantages

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