Transcript Universitat Bern - RLeu - Swiss health care system 1108

The Swiss Health Care System
Robert E. Leu
University of Bern
November 2008
The Swiss system in a nutshell
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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
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The Swiss system in a nutshell
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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
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Relatively high overall cost
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Regulated competition in the
health insurance market
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Health insurance as individual mandate, independent of
employment
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Universal coverage for all residents (# of uninsured < 1‰).
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Comprehensive benefit package
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Free choice between insurance companies and contract
options
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Free choice of physician and direct access to specialists in
canton of residence (except for managed care plans)
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Free choice of hospital (with regulatory limits)
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Regulated competition in the
health insurance market
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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
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Premium subsidies for lower income families
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Risk equalization scheme
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Cost sharing
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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
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Cost sharing
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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)
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Main Problems
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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
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Lessons for other countries
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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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