Works a universal free health system


Healthcare costs are rising so rapidly in Switzerland that everyone agrees: It cannot go on like this. In a series we highlight the most pressing problems. To begin with, a brief overview of how the Swiss healthcare system works.

This content was published on August 20, 2018 - 2:16 pm

The Swiss healthcare system is a mixture of the state and the private sector: private health insurance companies operate in a highly regulated market, service providers such as doctors and hospitals are partly private and partly state-owned.

In addition, health care is actually a matter for the cantons, but certain things are regulated by law at national level. That is why the Swiss healthcare system is rather fragmented and organized in a confusing manner. This is one of the reasons why it is one of the most expensive in the world.

Comparative studies have shownExterner Link that quality and care are good for this: Switzerland has a dense network of doctors and hospitals. In contrast to public health services such as in Great Britain (see box), patients in Switzerland do not have to wait months for an appointment.

Patients pay heavily

In Switzerland, every citizen has compulsory basic insurance and pays monthly premiums to a health insurance company of their choice. There is therefore competition between the registers; the premiums vary depending on the fund and canton. Anyone who lives in modest economic circumstances receives a premium reduction from the canton of residenceExternal link. The health insurers must provide basic insurance for every patient, even if they are sick or old. There is only freedom of contract for private supplementary insurance.

Patients have to contribute to the costs up to CHF 300 per year. You can also choose a higher deductible - up to CHF 2,500 - and then pay fewer premiums. In concrete terms, this means that if a patient chooses the highest deductible of 2500 francs, they have to pay their medical bills and medication themselves up to this amount. Only then does the cash register pay.

But that's not all: even if the deductible is exceeded, the patient pays a deductible of 10% for every service - even 20% for some medications - up to a maximum of 700 francs. In the case of hospitalization, the patient also pays a daily contribution of CHF 15.

Hospital financing: many actors

Nevertheless, the money is not enough, the state has to co-finance the hospitalsExternal link: In the inpatient area, the cantons bear 55 percent of the costs, the health insurances assume 45 percent. In the outpatient area, however, the health insurers pay 100 percent. This means that the cantons want to keep hospital stays as short as possible. The trend "outpatient before inpatient external link" is controversial; one speaks of "bloody discharges" when a patient is sent home too early.

The cantons keep hospital lists: These hospitals can bill through the basic insurance and receive public contributions, in return they have to ensure the medical care of the population (service mandate external link). The cantons also set treatment priorities and specializations so that not all hospitals offer the full range of medical services. This is used to plan "needs-based hospital care external link", which should also save costs.

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Health system ECO

Doctors are monitored

The health insurance (basic insurance) only has to pay for effective and economic benefitsExternal Link. Which these are results from the legal provisions as well as from lists. In the event of a dispute, a court must clarify whether the health insurance company has to pay for a specific treatment or medication.

The prices that doctors or other medical service providers are allowed to charge are clearly defined, be it in state-approved collective agreements, external link between health insurers and service providers, in law or by an authority. In the outpatient area, the individual service tariff "Tarmed" external link currently applies, in the inpatient area, however, a flat rate per case is billed (SwissDRGExterner link).

As part of the so-called profitability audits, the health insurances monitor the free practicing doctors. Anyone who becomes statistically conspicuous - that is, causes more costs than comparable doctors through prescriptions and treatments - has to reckon with a procedure and, if necessary, pay back fees. This is to prevent an "over-doctoring external link". For self-employed doctors - for example general practitioners, dermatologists or gynecologists - this means a not inconsiderable entrepreneurial risk, as millions have already been claimed backExternal link.

Switzerland depends on other countries

The deterrent effect of entrepreneurial risk is also relevant because there are too few medical staff in Switzerland - the shortage of general practitioners, midwives and nurses is particularly serious. Switzerland is therefore dependent on foreign personnel, which is considered problematic because of the different levels of training, among other things.

Two things have exacerbated the shortage of staff: the numerus clausus and the doctor's freeze. In the subjects of human medicine, dentistry, veterinary medicine or chiropractic, there are admission restrictions at Swiss universities: The study places are distributed to those applicants who do best in the aptitude test for medical studies (EMS) external link.

"Doctors' freeze" is the name of the controversial measure taken by the Federal Council, which in 2002 decided to limit the number of new doctors in Switzerland for the first time in order to stop the growth in health care costs (the higher the number of doctors, the higher the health care costs). The current doctor ban expires in 2019. Parliament and government are currently arguing about a succession plan.

Different countries, different healthcare

There are different models of health care: Some countries (e.g. Great Britain, Italy, Denmark, Cuba) have a national health service that is financed by taxes. In other countries - above all in the USA - there is a free market economy, everything is financed through private health insurance. In the so-called social security model (Germany, France), the financing runs through a statutory compulsory insurance.

Each model has advantages and disadvantages for the patient. In Great Britain, for example, patients do not pay premiums or medical bills because everything is financed through taxes, but they have to accept long waiting times, long distances and sometimes poor care. Media reportsExternal link draw attention to desperate conditions - for example, that patients die while they are waiting for a doctor's appointment.

Insurance models like those in Switzerland, on the other hand, are considered expensive and unfair, because the financial participation of patients in health costs is not dependent on income.

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