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Payment Methods

  • Basic health insurance has a minimum annual deductible of 300 CHF (Swiss franc; $255) per year

Why do people choose higher deductibles?

1. Cost-sharing

Once they meet deductible, enrollees pay 10% coinsurance for services

Obtain lower premium

If consumers choose a higher deductible, up to $2,125

How does this affect insurance competition?

2. Self-selection

Payment Methods

Covered services

9.Maternity costs, including 7 routine examinations, post-natal examination, childbirth and 3 breast-feeding consultations

10.Serious and inevitable dental treatment

11.Contribution to spectacles and contact lenses of CHF 180 per year for children and CHF 180 over 5 years for adults

12.Complementary medicines (alternative and homeopathic remedies)** After physician referral

13. Approved prescriptions

1.Hospital stay and outpatient care in any general ward of the canton of residency

2.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

3.Rehabilitation ordered by a physician, including health resorts

4.Physiotherapy and ergotherapy (max 9 sessions)**

5.Nutritionist/diabetic consultation (max 6 sessions)**

6.Emergency treatment abroad

7.Transportation and rescue costs

8.Legal abortion

Questions

Services not covered

Dental care

Long-term care (partially covered)

  • A few services are not covered because they are not considered effective
  • Must pay by out of pocket
  • Do you think the Swiss health care system is more effective than the United States'?
  • Why do you think the US's GDP is already significantly higher than the Swiss without national coverage?
  • Any other questions?

Basic insurance: What is covered?

The scope is broad compared with other OECD* countries

  • Including nearly all treatment and diagnostic services for illness, accident, and maternity

*OECD: Organization for Economic Cooperation and Development- a group of 21 nations to promote growth and trade

The Swiss Health Care System

Switzerland Healthcare System

Sickness Fund

Social health insurance (SHI)

  • SFs operate:
  • on a regional basis
  • or limited to a specific professional group
  • a legally mandated means of health care financing
  • Based on employment
  • Or individual contributions from payroll taxes
  • Operates under the Health Insurance Law
  • Improves access and affordability of care at contained costs
  • All residents are required to purchase basic health coverage from a government approved insurer
  • Insurers must be nonprofit with community-rated programs
  • 40% of all Swiss households and 1/3 of population receive premium assistance
  • High cost-sharing

A comparison to the

German HC system

Beveridge Model

Bismarck Doctrine

1942: Proposed universal coverage (unlike Bismarck model)

  • Funded through taxation
  • Covers many other non-health concerns (unemployment and retirement pension
  • Offered limited compensation & benefits to incite people to quickly return to work

1880: Covers the working population for accidents, diseases, disability and retirement

  • based on paid work
  • Unemployed and pensioner were excluded from the system

Germany's HC model

  • Incremental approach with progressive healthcare coverage for its citizens
  • HC system was also based on the Hospital Financing Act of 1972
  • HFA: the federal government controls hospital planning and construction

Timeline

Other reasons

  • Insured are incentivized to become price conscious while the insurers are not --> Minimal savings
  • Consumers are limited to their own canton with basic health insurance

Cost control is top priority

What do all of these reasons lead to?

Stagnate Enrollment Rates in MCOs

Several reasons:

Mandatory SF membership

  • Dissatisfied insured
  • lack of coordination between physicians and insurers
  • limited competition because of price regulation
  • It became mandatory that every citizen join a sickness fund

What does this mean?

  • Every citizen is entitled to a basic insurance
  • All basic insurers must offer the same benefit package
  • Mandatory basic insurance is regulated by the Federal Office of Public Health (FOBH)

Late 1990s

2006

1994

  • Low-income residents: Swiss government subsidizes tax money for those whose health care costs are more than 10% of their income
  • Aging population: Depends on pension plan
  • Outside of pension plan, the same rules apply as low-income

Managed Care Enrollment

Accounted for 6% of all insured

MCOs were credited for reducing HC costs by 20%

Reduced HC costs by:

  • Reductions in premiums
  • More enrollees
  • Increase in the use of primary care physicians as gatekeepers

Swiss health care basics 1

Swiss health care basics 2

On a national level

  • health care system is complex
  • involves public providers (hospitals)
  • involves private providers (private practices)
  • Heterogeneous: health service fees vary from one region to another
  • Adopted SFs as early as 1911
  • Switzerland consists of 26 cantons (regions)
  • Each canton:
  • offers basic health care coverage
  • has its own laws and regulations on health, hospitals, social aid programs and makes its own investments

Effectiveness

Demonstrated through controlled clinical studies

Covered services must meet three criteria

Appropriateness

Efficiency

A better cost-benefit ratio than available

The health service produces better outcomes than alternatives

Comparisons

Germany

Swiss HC system

USA

Universal HC coverage?

Universal coverage?

Can insurers profit from basic services?

Who manages health insurance?

Can insurers profit from basic services?

%GDP on HC

% GDP on HC

Universal coverage?

Yes

-The law

-Sickness funds

11.6%

Yes.

In the process: 40-50 million people uninsured

10.7%

15.3%

No.

Yes.

References

  • Total population: 7,664,000
  • Life expectancy at birth m/f: 80/84
  • 4 per 1000 live births will die under 5 years old
  • Total population: 310,384,000
  • Life expectancy at birth m/f: 76/81
  • 8 per 1000 live births will die under 5 years old
  • Total population: 82,302,000
  • Life expectancy at birth m/f (years): 78/83
  • 4 per 1000 live births will die under 5 years old
  • Simonet, D. (2010). Healthcare reforms and cost reduction strategies in Europe: The cases of Germany, UK, Switzerland, Italy and France. International Journal of Health Care Quality Assurance, 23(5), 470-488.
  • Leu, R. E. (2009). The Swiss and Dutch health insurance systems: universal coverage and regulated competitive insurance markets. New York, NY: Commonwealth Fund.
  • Navarra, Katja.(2011). Health Guide to Switzerland: The Swiss Healthcare System in Brief--a Guide for Immigrants to Switzerland. Werkstrasse: Swiss Red Cross.
  • (2000). Healthcare Systems in Transition. European Observatory on Healthcare Systems. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0003/96411/E68670.pdf.
  • Enrollees can switch insurance up to one time per year
  • Insurers can quote premiums for regions established by the FOPH
  • Basic insurance can be supplemented by a private insurance
  • Risk equalization: Insurers must accept all applicants and cannot vary premiums based on health conditions
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