Jennifer Parker

ECON 3330.002

Luba Ketsler

13 October 2016

Switzerland: Nationwide Healthcare, Public and Private

When examining the healthcare systems of many European countries, finding that most

of them provide healthcare to nearly all people within their countries comes as no surprise. In

this case, Switzerland is no exception as far as vast coverage is concerned. Switzerland is a

relatively small country with a population of roughly 8 million that spend 11.2% of their GDP on

healthcare (Nikola). However, most of other European nations generally fund these healthcare

systems through public taxes or through their employers, but instead the Swiss healthcare system

is funded by individuals through contributions into health insurance programs (Expatica). This

means that people are not receiving healthcare insurance directly through government programs

and are instead able to choose their own insurance company in the free market. Swiss law states

that anyone in the country of Switzerland must enroll in the most basic required form of Swiss

health insurance no later than 3 months of being within the country (Expatica). This law is

largely responsible for almost universal coverage in Switzerland. However, even though people

are purchasing insurance from private companies does not imply that the government does not

play a role in public healthcare. For those who cannot afford the very expensive health insurance

provided in Switzerland, the government pays large subsidies to help cover these people who

would otherwise not be able to obtain coverage (Rovner). Much of the way the Swiss healthcare

system is run could appeal to both Republicans and Democrats in America making parts of their

policies worth exploring in The United States.

 The way that Switzerland has set up their healthcare policies makes residing in the

country and not having health insurance almost impossible. If you are in Switzerland for less

than three months, you may be exempted from the requirement for holding basic health

insurance if you have a European Health Insurance Card (EHIC), your own health insurance

policy, travel insurance or a company healthcare plan. After three months everyone has to

have organized coverage with an authorized Swiss insurer even if you have an international

health insurance policy, as these are not usually recognized in Switzerland (Expatica). To the

Swiss, it is normal to be required to have health insurance. To help keep this policy in place, the

government arranges it so that if payment for healthcare accounts for 8% or more of ones

personal income, subsidies are awarded to help cover costs. In fact, roughly 30-40% of Swiss

citizens receive some form of subsidywhere the poorest can receive up to 100% coverage

(Schwartz & Royce). Since all Swiss residents have health insurance, they choose to play an

active part of how the health programs they take part in are structured. The Swiss population

has repeatedly voted for retaining consumer choice (e.g., free choice of providers and insurers)

even if it comes at a higher cost. One of the main reasons why voters rejected the draft law on

integrated care was concern about losing the freedom to choose one's physician (Nikola). Their

active participation in both healthcare policy and the consumption of healthcare has helped

increase the overall health of the Swiss population and keep their satisfaction with their

healthcare system high.

Part of this system includes the fact that all health insurance companies are privately

owned and operated. There are roughly 80 Swiss insurers to choose from, each offering the same

basic health package. They are required to accept anyone who applies for coverage regardless of

preexisting conditions. Some of the medical services covered on the basic health insurance
policies include out-patient treatment, emergency treatment, medical transport, medications,

maternity, vaccinations, some alternative therapies, and some treatment outside of the country

depending on the circumstances (Expatica). Every year, adults have to pay the first CHF 300

[~306 USD] of any medical treatment themselves, except for maternity services. This

contribution is called an excess. The insurance will only pay what exceeds the excess and even

then, the patient has to pay 10 percent of that amount. This is called the deductible and is

limited to CHF 700 [~715USD] per year or CHF 350 [~357 USD] per year for children. If you

need to go to hospital, you have to pay CHF 15 [~15 USD] per day (Expatica). These amounts

are fixed for basic health benefits, but premiums vary from company to company. While the

health benefits from the basic insurance plan may cover the majority of peoples needs, many

Swiss citizens elect to fill in the gaps of their coverage with supplemental insurance. While the

basic health benefits in Switzerland are much more extensive than most, there are still a few gaps

in coverage that about 70% of the population chooses to correct with some form of

supplementary insurance. This supplement mainly includes items such as private hospital rooms,

dental coverage, and ensuring coverage for all drugs and services (Royce). With medication,

there exists a list of drugs which are covered in the basic health benefits without question, but for

medications outside of this list or medications where one elects to use a brand name when a

generic is available, will incur a coinsurance payment of 20%. Due to reasons like this and many

others, Switzerland has a higher level of out-of-pocket (OOP) expenditure than most countries

[accounts for] about 28% of Swiss health spending and lower direct government funding

(Royce).

Even though healthcare is expensive in Switzerland doesnt meant that people refrain

from consuming it on a regular basis. Under most health insurance plansexcept for some of the
cheaper policiespeople can choose their own primary care physician. Unlike many countries

where primary care physicians are the gatekeepers to healthcare, people can elect to see a

specialist without a referral from another physician (Expatica). The ability to choose any

physician for an appointment gives policy holders a lot more control over their health and

therefore they require more education to make informed decisions. When people receive

prescriptions from their physicians, they go fill it at a pharmacy where if they are a new patient,

they are charged a small one-time fee to start a new patient file to keep at the pharmacy. This is

true for all pharmacies so it gives patients incentive to use the same pharmacy every time they

fill prescriptions. However, if your pharmacy is closed, there exist emergency SOS pharmacies

available for after-hours prescriptions that need to be filledthe prices of which are higher due

to the unorthodox hours (Expatica). This gives people more control over their treatment as well,

especially in an emergency situation. Without this service, more people would need to go to the

hospital for emergency services. Interestingly, the Swiss healthcare system has an unusual focus

on after-hours healthcare. The 26 cantons of Switzerland (like states in the US) are responsible

for after-hours care by organizing care networks with their affiliated physicians to provide

ambulance services, hospital emergency services, walk-in clinics, and telephone advice lines

(Camenzind). The fact that patients are able to access prescription medication or after-hours care

more easily in a time sensitive situation frees up space in emergency rooms of hospitals and

keeps the population healthier with such large access to preventative treatment.

Hospitals in Switzerland operate under different circumstances than private clinics do.

Unlike most medical appointments, people cannot choose to check themselves into the hospital

without the consent of a doctor unless the situation is an emergency (Expatica). But even

emergencies seem to occur less regularly in Switzerland than they would in countries like the
United States. In fact, hospital physicians like Edouard Battegay at the University of Zurich say

universal coverage also lowers costs by reducing emergency room visits (Schwartz). He states

Ive seen things in the U.S. that Ive never seen here; it was a state of disaster, he said.

Chronic disease management is better here. If you dont treat hypertension, you treat strokes.

Not treating patients is expensive (Schwartz). Though people are not required to see a general

practitioner to request an appointment from a specialist, people still seem to be consuming

enough preventative treatment to keep themselves healthy enough to avoid many expensive

health conditions.

On the other side of healthcare, dentistry in Switzerland differs greatly from that of other

countries. On account of the fact that dentistry is not covered on basic health benefits, one must

have supplemental private insurance to make this already expensive service slightly more

affordable. Children receive checkups for free through their schools, but if problems arise, the

cost of the services must be paid for by the family (Expatica). Because each individual must have

their own health insurance, including children, these supplemental plans can become pricy quite

quickly. However, even though the added cost of dentistry is expensive, it doesnt seem to affect

how many people in Switzerland still seek out treatment. In fact, regular patients normally visit

their dentist for re-examinations every 6 to 12 months. About 90% of the population access

dentistry in a 2-year period, and a dentist would normally have a list of about 1,500 regular

patients (Kravitz). Even without mandatory coverage for dental treatment, the Swiss still seem

to take an active role in their preventative healthcare.

While its highly beneficial that the population of Switzerland so actively seeks out

preventative care, this does not always bode well overall. It is true that preventative care is much

less expensive than emergency or acute care, but this can instill the idea that treatment is needed
for any little problem when in fact the problem may resolve itself; the concern on the rise is

overtreatment. Because of the comprehensive benefits package of the mandatory health

insurance scheme and the high density of health care resources, there is evidence of supply-

induced overconsumption (Nikola). Overconsumption can lead to problems of scarcity in

healthcare which could make the overall Swiss population unhealthier. If those who truly need

medical attention are not able to receive it because other patients are acquiring unnecessary

treatment, the system becomes tied up and resources are not distributed efficiently. The Swiss

Medical Board is an independent health assessment organization that provides suggestions to

promote clinical and cost effective treatment. Recently, they recommended that [f]or inpatient

care, DRGs were introduced into the payment system in 2012 as an incentive for greater cost-

efficiency. It remains to be seen, however, whether the economic pressure perceived by hospital

physicians will lead to compromises in the quality or equity of patient care (Nikola).

With a majority of the population taking good care of their personal health and the fact

that people are living longer now than ever, the concern of an aging populations healthcare

needs is on the rise in Switzerland. If medical resources are already tied up with unnecessary

medical treatment, the aging population may be the patients who suffer the most from this loss. If

this is not enough incentive, the requirements of an aging society reinforce the need to provide a

well-coordinated continuum of care, including social services and nursing care. Costs are also an

issue: in 2013, private nursing care cost the country 3.55 billion francs (about $3.90 billion)

(Nikola). The chance for this price to rise even higher in the coming years remains quite possible

due to the fact that many women choose to work outside of the home. Because of this, the

elderly will increasingly need to rely on external services. Insurance for long-term care, however,

is still in its infancy. In addition, health care personnel are becoming increasingly scarce: as baby
boomers retire in the years to come, it will be challenging to recruit the personnel to replace

them (Nikola). If this new long-term health insurance system fails, the overall cost of fixing the

system will cost a fortune. People will not be able to receive healthcare efficiently or at a decent

price, causing much anger within the population that requires nursing or hospice services.

While the Swiss system has room for improvement, there are many aspects of it that

could be worthwhile for the United States to adopt. The ability to shop for insurance in the free

market would appeal to many in the United States by giving the public full choice over who they

receive their health insurance from and what it covers. What might be harder to convince the

public to go along with is the strict legal requirement to have health insurance for every person.

While the Affordable Care Act has already put a similar requirement in place where people are

charged a fee at the end of the year if they do not have some form of insurance, this idea was not

popular with many Americans. While Swiss health policies cannot please everyone, there are

aspects of it that would appeal to both sides of the bipartisan political system in the United

States. Republicans would align with the fact that health insurance is not provided by employers

or the government but instead in the free market and Democrats would prefer policy that requires

universal coverage for all, including subsidies to help those who cannot afford the expensive

insurance. However, the healthcare policy in Switzerland may work so smoothly because of the

relatively small population the country has to cover. With more people comes more problems;

most of all it comes at a higher cost. Americans are already angry with the extremely high

expenses tied to healthcare in the United States, so many changes would have to first occur in

U.S. healthcare policy before people would be willing to adopt parts of a foreign system that

could potentially increase costs for the public in the short-run. Switzerland also has a higher ratio
of physicians available per person, so access would also be an important issue to address first in

the US before implementing any new policies.

 References

Camenzind, P. The swiss health care system. Retrieved 10/07, 2016,

from http://international.commonwealthfund.org/countries/switzerland/

Expatica. (2012). The swiss healthcare system:

A guide to accessing the swiss healthcare system: Health insurance, visiting the GP,

seeing a specialist, going to hospital and emergency services. Retrieved 10/07, 2016,

fromhttp://www.expatica.com/ch/healthcare/Getting-healthcare-in-Switzerland_103130.html

Hospitals in switzerland. (2016). Retrieved 10/07, 2016,

from http://www.expatica.com/ch/healthcare/hospitals-in-switzerland-major-swiss-

hospitals_102077.html

Kravitz, A., Bullock, A., Cowpe, J., & Barnes, E. (2014). MANUAL OF DENTAL PRACTICE 2014

switzerland.5, 10/07/2016.

Nikola Biller-Andorno, M.D., Ph.D., & Thomas Zeltner, M. D. (2015). Individual responsibility and

community solidarity the swiss health care system. Retrieved 09/29, 2016,

fromhttp://www.nejm.org.libproxy.utdallas.edu/doi/full/10.1056/NEJMp1508256#t=article

Rovner, J. (2008). In switzerland, A health care model for america?. Retrieved 10/07, 2016,

from http://www.npr.org/templates/story/story.php?storyId=92106731

Royce, R. P. (2014). The enigma that is swiss health care. Retrieved 10/07, 2016,

from http://www.managedcaremag.com/archives/2014/2/enigma-swiss-health-care

Schwartz, N. D. (2009). Swiss health care thrives without public option. Retrieved 10/07, 2016,

from http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=0