What? No Waiting Lists? the Swiss Health System Is a Model That Is Envied for Its Universal Coverage and Standard of Care. Everyone Has Insurance and There Are No Queues for Treatment. So Why Are People Complaining?

Abstract

year as Switzerland's Federal Office of Public Health (FOPH) announces the annual round of health insurance premium increases, this nation of 7.5 million people lets out a collective groan. Last year, the pain was greater than usual. Concerned about the depletion of cash reserves insurers' coffers, the FOPH allowed rises of up to 14.6% for basic insurance premiums depending on the canton. That hurt. Since 1999 the Swiss have seen health insurance costs rise by 50%, according to the FOPH. From 2008-2009, the price hike was significant enough to cut 0.1% from rising household disposable income. Nadia Bouchardy does not need an announcement to know that a sizeable portion of her family's income is being spent on health. Married to an ambulance driver with two young daughters, the family has an annual income of 90 000 Swiss francs (US$ 83 000) before taxes and insurances. year around 10 500 Swiss francs (US$ 9700) or 12.5% of their income goes on health insurance and extra expenses such as dental care. Last year, Bouchardy, who is aged 41, had an operation and had to pay 10% of the costs of the operation, medicine and her stay hospital. (In out-of-pocket expenses are capped to ensure families do not suffer what is termed catastrophic expenses). We are not very happy with the health insurance system Switzerland, she says. Every year we pay more and we get less. The lists with items that are not covered anymore by the health insurance gets longer. Some items like glasses or basic medicine are not fully covered, so we have to pay these costs out of our non-health budget. So far we are lucky we have not been forced to borrow money order to pay the health bill. The Bouchardy family represents how middle-income Switzerland is being squeezed financially. They earn too much to benefit from the health subsidy received by households that spend more than about 8% of their income on premiums (the level of subsidy depends on the canton). Some 40% of households receive the subsidy--either through a lower premium or tax rebate--which is the government's mechanism for preventing the cost of insurance from unfairly disadvantaging low-income families. Professor Alberto Holly, of the University of Lausanne, is an expert Switzerland's health financing system. He points to a system that is envied for its universal coverage, its equity, standard of care and lack of waiting lists. of the strengths of the Swiss system is equity with respect to health risk and patient ratio. No one is penalized for age, gender or medical history. However, it is not totally equitable and is regressive respect to income, he says. Under the Swiss constitution, the Federal Government is responsible for managing the health insurance but has limited responsibility terms of health policy. Instead, this energetically democratic country has a decentralized system which the 26 cantons are autonomous and choose how to organize their own health care. results a wide disparity terms of insurance premiums, which are usually paid by householders, not employers. [ILLUSTRATION OMITTED] Since 1996, it has been illegal not to have basic health insurance Switzerland. There are 82 not-for-profit insurers that offer policies costing around 350 Swiss francs (US$ 325) a month per adult. No one can be turned away under this scheme, known as LAMal. Further, some 44 companies offer complementary forms of insurance, which allow benefits such as dental treatment and access to luxurious hospitals, and these companies are free to choose clients according to their risk profile. One characteristic of Switzerland's health-financing system is its expense. This is not an efficient system, says Holly, in that it has not been possible to control costs. The result is that Switzerland has the third most expensive medical system the world. …