The swiss healthcare system without the health care finances
By: Rafael Rodriguez
I.) Overview of the Systema)Definitionsb)Introduction to Swiss HealthCare SystemII.)Health Care Packagesa)What is Offered?b)Insurance Policiesc) Types of CareIII.) Issues with the Carea)Pros and ConsIV.) Summationa) Is the Swiss System a well-working system?
HealthCare Systems • The aim of the HiT initiative is to provide in Transition (Hit) relevant comparative information. • Compiles current, detailed, and comparable data on healthcare systems. Responsibilities: • To support policy-makers and analysts in the development of HealthCare systems in countries of Europe and beyond.
• The WHO provides counseling on issuesWHO = World Heath detrimental to health and meditating the Organization creation of partnerships. • Providing research data that is used to create or modify standards of policies. The research is based off of ethical and evidential reasoning. Responsibilities: • Uses technical support, develops sustainable institutions, and assesses the health situations of each country by delivering a comprehensive analysis of newly-changing health trends.
OECD = Organization • To promote policies that will improve the for Economic Co- economic and social well-being of people operation and around the world. Development • OECD collaborates with governments to understand what creates economic, social and environmental change. • Measures productivity and global flows of trade and investment. Responsibilities: • 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.
• Canton – Member states of the Swiss Federation with each of their own constitutions andQuick Bio: Switzerland governments but are not limited known as the “Swiss to the power of the Swiss Federal Confederation.” Constitution. • At an institutional level, the cantons and municipalities were almost exclusively responsible for health and welfare.
Switzerland’s • Came into effect in 1996 under the Health Insurance current Law named (LAMal). Health Care • LAMal stands for the Swiss Federal Law on System. 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.
Basic Package – Individuals can only seek treatment in their canton of residency. • i.) Sickness Insurance The Basic Package • ii.) Maternity Insurancehas three categories: • iii.) Accident Insurance
Examples 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
Universal Coverage: An essential add-on thatguarantees 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 wordsthey cannot vary premiums based on the health status of each consumer.
To make sure insurers follow the rules Foundation 18 was created. Foundation 18 is a risk equalization solidaritythat 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
Federal Office of Social Insurance: Governs insurancecompanies actions.Choice of Insurer and Health Care Funding: Insurers arerequired to register with FOSI to comply with the monitoringof insurance companies by the government.This system allows individuals to choose from 80 to 90different plans. Consumers also have the choice of switchingtheir insurance provider up to two times per year.
Premiums – Since companies are allowed to compete on price-there is a differing cost ofhealth 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 highestpremiums with a 300 CHF deductible was 89% in the Zurich area. This suggests thatfactors other than deductibles are affecting the price of plans and many believe that it isin fact predominantly the result of a poor risk equalization system”(Source: civitas.org.uk)
Deductibles – A form of payment to avoid moral hazard and to allow treatments to be covered by the Individuals who opt for higher insurance. (Think of it as a fee that deductibles pay lower flat-ratemust be paid to continue coverage) premiums. Depending on the insurer, deductibles vary.“To safeguard solidarity (Foundation “Costs exceeding the deductible are 18) the scheme is regulated by the paid for by the insurer. Patients still Federal government, which sets a have to pay 10% of the remainingminimum and maximum deductible balance known as the co-payment. To of 300 CHF ($325.44) and 2,500 CHF prevent outrageous costs this co- ($2712) respectively; (for children payment is capped at CHF 700 ($759)these figures are 100 CHF ($109) and per year by cantons” 600 CHF ($651).” (Source: civitias.org.uk)
No-claims bonus scheme: A rule that discouragesoveruse of services. Individuals that do not submit claimsreceive an increasing reduction in their premiums eachyear.After 5 years this can reach as much as 45% - a clearincentive to adopt healthier lifestyles.
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)
Primary Care: Providers are paid through the reimbursements from the insurers. The PC is made up of independent General Practitioners and Specialists. The majority of individuals register with a permanent physician but the ones that don’t have the freedom to choose between all PC providers in their canton. Secondary and Tertiary Care: There are public, publicly subsidized and private hospitals in Switzerland. The public hospitals may be operated by the canton in which they are located, associations of municipalities, individual municipalities or independent foundations.The private hospitals do not receive any financial subsidies but are financed solely by payments made by health insurance companies and patients). Private hospitals included in the cantons’ hosptials list can be reimbursed for services under compulsory health insurance. (Source: euro.who.int)
There is no fixed cap on Health Care spendingIncentives for policieslead individuals to be cost-effective the premium benefitsProviders are constantlyimproving policies andplans to meet the needs of the individuals.
Affordability : BasicPackage premiums haveincreased by an avg. 5%per year and out-of-pocketexpenditure is high.Out-of-pocket expenditureaccounts for 30.5 per centof total health expenditurein Switzerland.
Comprehensiveness of Basic Package: The BP has somany benefits that are being added, which results inincreased costs for everyone.Proposed Solutions: Shifting some of the lower-endtreatments to the supplementary insurance coverage.Since there is a competitive market, the reform wouldhave to guarantee that those with chronic diseases willtreated since it would no longer be in the basic package.
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?