2. I.) Overview of the System
a)Definitions
b)Introduction to Swiss HealthCare System
II.)Health Care Packages
a)What is Offered?
b)Insurance Policies
c) Types of Care
III.) Issues with the Care
a)Pros and Cons
IV.) Summation
a) Is the Swiss System a well-working system?
3. 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.
4. • The WHO provides counseling on issues
WHO = 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.
5. 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.
6. • Canton – Member states of the
Swiss Federation with each of
their own constitutions and
Quick 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.
7. 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.
8. Basic Package – Individuals can only seek treatment in their canton
of residency.
• i.) Sickness Insurance
The Basic Package
• ii.) Maternity Insurance
has three categories:
• iii.) Accident Insurance
9. 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
10. Universal Coverage: An essential add-on that
guarantees 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 words
they cannot vary premiums based on the health status of
each consumer.
11. To make sure insurers follow the rules
Foundation 18 was created.
Foundation 18 is a risk equalization solidarity
that 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
12. Federal Office of Social Insurance: Governs insurance
companies actions.
Choice of Insurer and Health Care Funding: Insurers are
required to register with FOSI to comply with the monitoring
of insurance companies by the government.
This system allows individuals to choose from 80 to 90
different plans. Consumers also have the choice of switching
their insurance provider up to two times per year.
13. Premiums – Since companies are allowed to compete on price-there is a differing cost of
health 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 highest
premiums with a 300 CHF deductible was 89% in the Zurich area. This suggests that
factors other than deductibles are affecting the price of plans and many believe that it is
in fact predominantly the result of a poor risk equalization system”
(Source: civitas.org.uk)
14. 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-rate
must 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 remaining
minimum 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)
15. No-claims bonus scheme: A rule that discourages
overuse of services. Individuals that do not submit claims
receive an increasing reduction in their premiums each
year.
After 5 years this can reach as much as 45% - a clear
incentive to adopt healthier lifestyles.
16. 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)
17. 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)
18. There is no fixed cap on
Health Care spending
Incentives for policies
lead individuals to be
cost-effective the
premium benefits
Providers are constantly
improving policies and
plans to meet the needs
of the individuals.
19. Affordability : Basic
Package premiums have
increased by an avg. 5%
per year and out-of-pocket
expenditure is high.
Out-of-pocket expenditure
accounts for 30.5 per cent
of total health expenditure
in Switzerland.
20. Comprehensiveness of Basic Package: The BP has so
many benefits that are being added, which results in
increased costs for everyone.
Proposed Solutions: Shifting some of the lower-end
treatments to the supplementary insurance coverage.
Since there is a competitive market, the reform would
have to guarantee that those with chronic diseases will
treated since it would no longer be in the basic package.
21. 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?
