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Switzerland’s
Health Care System
Jaroslav Molik, Swiss Reinsurance Company 2007, Jaroslav Molik All Rights Reserved
After USA the most expensive health care system in the world; ~68% (public source) / ~32% (private source) ~21% Medicaments /~23% In-hospital~14% Out-of hospital / ~23% Doctors / ~19% Others Most of the growth in out-of hospital; ~88 (The 4 top companies have >500’000 members); Content – Switzerland’s Health Care System ¾ Introduction to the Swiss Health Care System ¾ Key issues of the Swiss Health Care System ¾ Discussion: Unique health insurance company ¾ Future of the Swiss Health Care System Quality of health care
In general excellent
everyone gets the best available health care;
Access to health care
In general very good
everyone gets access to the health care needed;
Cost of health care
Very unsatisfactory
very high / each year increasing;
How much is an individual prepared to pay for his or his
How much can an individual afford to pay for his or his
Ongoing improvement of medical technology; Mostly indemnity plans with no influence on volume andquality of health care delivery Content – Switzerland’s Health Care System ¾ Introduction to the Swiss Health Care System ¾ Key issues of the Swiss Health Care System ¾ Discussion: Unique health insurance company ¾ Future of the Swiss Health Care System a) unified health care service catalogue (regulated) b) based on cost principle (versus service principle) a) add on: dental care, private, alternative medicine… Premium determination:ƒ Basic Health Insurance (supervised by the state) a) per head premiums (not income / age / risk related) (support via taxes for low-income insured) b) premium depends on the following factors i) choice of the retention (EUR 195/…./EUR 1’625)ii) choice of the model (HMO etc) iii) choice of health insurance company & domicile Premium determination:ƒ Additional Health Insurance b) premium depends also on the following factors i) choice of health insurance package;ii) choice of the model (HMO etc); iii) choice of health insurance company & domicile; a) No underwriting at all b) Each application to be accepted by the health insurer a) Underwriting according to health insurer’s guidelinesb) loading / rating / declining / postponing & canceling allowed ƒ No need to have the Basic Health Insurance & Additional Health Insurance with same health insurance company; ƒ A health Insurer can decide to withdraw offering Basic Health Insurance completely from a region; ƒ The insured can change each the carrier of his Basic Content – Switzerland’s Health Care System ¾ Introduction to the Swiss Health Care System ¾ Key issues of the Swiss Health Care System ¾ Discussion: Unique health insurance company ¾ Future of the Swiss Health Care System 1)
Increasing health care premiums
Æ low-income insured even poorer;
2)
Equal premiums for everyone
Æ re-allocation of the funds from young to old (poor to
rich) / ageing population;
3)
Missing real competition
Æ prices are to high / health care not enough efficient
(50% of in-hospital costs not under control;
4)
Defined / fix catalogue of health care services
Æ paying for coverage not wanted / prices rise if
coverage extended (e.g. Viagra);
5)
Obligatory premium payment
Æ motivation to use health care services;
Improvement and better cost control (better model for
risk adjustment);
Increase insurance companies purchase power of
health care services
(no contributions anymore to the
hospitals by the cantons);
Reduction of the hospital “surplus” capacity;
Cost reduction in respect of medicaments (generics,
break the lobbying of the pharmacy industry);
Long term improvement by changing the governance
(Now: 26 more or less autonom health care systems);
Content – Switzerland’s Health Care System ¾ Introduction to the Swiss Health Care System ¾ Key issues of the Swiss Health Care System ¾ Discussion: Unique health insurance company ¾ Future of the Swiss Health Care System Pros & Cons to have just one health insurance company a) Get rid of the “hunt for good risks” (not ethical)b) Separation of basic and additional health insurance; c) Reduction in administration costs (~EUR 200 million)d) Expensive and complicated system of risk adjustments between the health insurance companies; e) Avoiding the yearly insured turn over between health f) More solidarity due to income dependent premiums;g) High quality / no two-tier health care system; Pros & Cons to have just one health insurance company a) No competition anymore (no efficient medicine);b) Creation of an “administrative monster”;c) Doctors no room for negotiations due to monopole;d) Less innovations for new models;e) Expectations of even higher costs; Æ Declined in voting of 11 March 2007
Content – Switzerland’s Health Care System ¾ Introduction to the Swiss Health Care System ¾ Key issues of the Swiss Health Care System ¾ Discussion: Unique health insurance company ¾ Future of the Swiss Health Care System 1)
More competition elements
to increase efficiency of health care;
2)
More freedom of choice
shift rather health care services from the basic
coverage to the additional coverage;
3)
More risk adjusted premiums
in the sense of motivating to prevent health care costs;
4)
Wishful thinking to have 1-tier health care system
accept the fact that some have the money to pay for
additional coverage;
5)
Early health care education in school
1)
Introduction of Insurance Card (planned in 2008)
improvement of data quality;

2)
Risk equalization extends (until 2010);
3)
Review the basic health care service catalogue;
4)
Rethink the hospital financing (up to 50% financed
by cantons & Reduce hospital bed overcapacity;

5)
Actions against providers working
uneconomically;

6)
Contractual freedom;
7)
Managed Care models;
Future of
the Swiss Health Care System (D)
Æ INCREASE EFFICIANCY OF
HEALTH CARE SERVICES
RESULT:
BETTER COST CONTROL!
The Swiss Health Care System
For further questions:
e-mail: Jaroslav_Molik@swissre.com

Source: http://30923.vws.magma.ca/IAAHS/Colloquia/Cape_Town/Molik.pdf

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