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Swiss Health Care a time for reassessment

This article provides an overview of the Swiss healthcare system, including its basic principles, reforms, and the satisfaction of healthcare consumers. It discusses the role of insurance, individual responsibility, and private providers. It also explores the financing of healthcare and the impact of cost containment measures. The article highlights the effects of centralization and public dissatisfaction, as well as the need for sustainable healthcare models and approaches to covering risk and poverty. Finally, it explores the concept of health savings accounts and other strategies for providing affordable and predictable healthcare.

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Swiss Health Care a time for reassessment

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  1. Swiss Health Carea time for reassessment Dr Alphonse Crespo Workshps on Health Insurance Beijing 2008

  2. Basic Principles • GUARANTY OF ACCESS • GOVERNEMENT SUBSIDIARITY • REGIONAL AUTONOMY • INSURANCE BASED • INDIVIDUAL RESPONSIBILITY • PRIVATE PROVIDERS

  3. Who pays? 11.6% of GDP IS INVESTED IN HEALTH CARE 30% out of pocket 25% public subsidies 35% social insurance 10% private insurance

  4. Health Consumer SatisfactionThe European Scene  European Health Consumer Index: Insurance based systems Do better than National Healthcare Services

  5. Reforms Until 1994 Voluntaryinsurance* Private & subsidized providers Wide Cantonal autonomy • After 1994 • Mandatory insurance • Cartel Dominated model • Cost containment oriented • Subsidies target indlviduals • More federal regulatory power

  6. Swiss Hospitals • 230 public hospitals • 3.5 beds per 1000 inhabitants • 136 private hospitals (mostly in bigger cities) • 0.7 beds per 1000 inhabitants • AN EXPANDING SECTOR • ±30% of global health expenses

  7. PRIVATE HOSPITAL SECTOR Private Hospitals Open to patients with supplementary insurance Some exceptions for ambulatory treatment Public hospitals Offer private wards

  8. Swiss Hospitals - dual financing • Public hospitals financed through: • State subsidy: 55% - Insurance : 45% • (Out-patients: insurance + copayments) • As from 2009-2012: • No public subsidies for investments & hardware • No public cover for deficits • Diagnostic related based (DRG) reimbursement • List of approved hospitals (including private) • More trans-cantonal access • More federal planning of hospitals

  9. Effects of cost containment • Reduction of global number of public Hospitals • Mergers of local or regional hospitals • Centralization of specialty units • Shift of care to larger cantonal or University Hospitals • Incentives for in & out surgery • Restriction of doctor practices

  10. Effects of centralization? How Safe is Big ? Comparis Study on Swiss Public Hospital Outcomes and critical incidents - Aug. 2007

  11. Public dissatisfaction : Clear Signals March 2007: Vote on Single National Insurance Provider 72% NO June 2008: Regulation of doctor offer 69.5% NO

  12. Sustainable health care European models conceived in 19thC not adapted to challenges of the 21st C • Basic Concept for reform • RISK • PROBABILITY • POVERTY • need specific approaches

  13. Covering for RISK Market based Catastrophic Insurance High deductibles & co-payments = Cost-consciousness Individual responsibility Affordable premiums Mandatory Health “Insurance” First dollar coverageor low deductibles: Covers risks AND certaintY Provides for minor ailments = Overuse & waste High premiums Rationing

  14. Providing for PREDICTABILITY • Health Savings Accounts • Adapted to chrono-physiology of health • Avoid inter-generational gridlocks • Allow for more transparency & consumer pressures on prices • Create capital

  15. Health Savings Accounts South Africa(+ Private Insurance) 1994 Covers 5% of Population USA(+ HDHP) 1997- 2002 Test phase 2003 - 2006 Integrated to law China ? Urban pilot experiments since 1994 From1984: SINGAPORE Medisave : 84% of Population (+ Social insurance for high risk)

  16. Private & corporate philanthropy • NGO’s & voluntary help • Micro-credits (health banking) • Micro insurance • Tax credits • Guaranteeing loans • Health Vouchers • Targeted social services Caring for POVERTY

  17. The pillars of sustainable health care + + ++ Risk insurance & pooling for catastrophic health expenditures Micro-insurance Philanthropic initiatives -- Health vouchers Public Social Services for the needy Health Savings Accounts for predictable health expenditures

  18. THANK YOU FOR YOUR ATTENTION +

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