Health Care Abroad: Switzerland
Q.The Swiss health care system relies on public-private approaches that have been recommended as models for the United States. What are the similarities?
A.In 1996, Switzerland instituted an individual mandate by which people are legally required to purchase health insurance in a competitive market. People buy coverage from private insurers, and the government provides subsidies for those who can’t afford coverage. About a third of the population receives subsidies.
Q.Is there an employer mandate, too?
A.No, it’s an individual mandate. Group health insurance does not exist in Switzerland.
Q.That’s a major difference between the Swiss system and most of the proposals in Congress. Are there others?
A. The most important difference is that health insurance in Switzerland is provided by nonprofit insurers — though some are affiliated with for-profit companies that offer supplemental policies along the lines of Medigap in the United States. The basic benefit package is defined by law and is quite generous. Maximum drug prices are regulated.
Q.Do the Swiss have a choice among policies and insurance companies?
A.They do. The policies differ mainly on deductibles. The standard annual deductible is 300 Swiss francs, or about $200 for adults. There is no deductible for children under 18. Individuals can reduce their premiums by electing plans with higher deductibles — up to 2,500 Swiss francs, or about $2,000. Once the deductible has been met, you pay coinsurance of 10 percent of covered expenses, up to a maximum of 700 Swiss francs. For brand-name prescription drugs, you pay 20 percent of the price if there’s a generic equivalent.
There are also some managed care plans, in which about 12 percent of the people are enrolled.
Q.Is there a public option in Switzerland?
A.There is no government-run plan to compete with the private nonprofit plans. But health insurance is considered social insurance. It’s not a for-profit enterprise.
Q.Can the Swiss go to any doctor they want?
A.For the most part, although there are some managed care plans with networks. Otherwise, the Swiss have a free choice of physicians and specialists. There is no “gatekeeper” system limiting their access to specialists.
Q.What does the Swiss health system do particularly well?
A.They’ve achieved near universal coverage. But even before the reform, 96 percent of the population was covered. They’re a very risk-averse society. The culture is that you just don’t go uninsured. Now, with reform, they’re close to 99 percent. But the country is still struggling with how to handle individuals who fail to comply with the mandate — mainly the poor and recent immigrants.
Q.How is the quality of care?
A.The quality of care is excellent. Waiting times are not reported to be a serious problem in Switzerland, and most people can get the services they need quite expeditiously. Modern, high-technology services are readily available. Coverage of some new drugs and procedures, however, is reviewed for effectiveness, and some drugs and procedures available in other countries may not be available in Switzerland if they are not considered to be cost-effective.
More about the Swiss healthcare plan here.
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Swiss Healthcare System: Part II
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