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The Swiss Health Care System. Robert E. Leu University of Bern November 2008. The Swiss system in a nutshell. Highly decentralized (26 cantons/states) Federal government acts mainly as regulator (Federal Health Insurance Law) and supervisor

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the swiss health care system

The Swiss Health Care System

Robert E. Leu

University of Bern

November 2008

the swiss system in a nutshell
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
the swiss system in a nutshell3
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
regulated competition in the health insurance market
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)
regulated competition in the health insurance market5
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
cost sharing
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
cost sharing7
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)
main problems
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
lessons for other countries
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