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The Swiss Health Care System
Does the Swiss model translate? Strengths and
weaknesses
Pierre A. Clavien
Department of Visceral and Transplantation
Surgery www.surg.ch
University Hospital Zurich
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The Swiss Health Care SystemOrganizational Chart
of the Swiss Health Care System
Decentralization
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The Swiss Health Care Systemexcellent quality
quite expensive

• Other notable features
• Preferences of (potential) patients determine
  structure of the system (e.g. votation on
  hospital, politicians etc..)
• Decentralization of political power
• High degree of competition
• Unusual public / private mix

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The Swiss Health Care SystemHealth Insurance

• Three components
• Compulsory basic social insurance
• Voluntary supplementary insurance
• Old-age and disability insurance

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The Swiss Health Care SystemHealth Insurance

• Compulsory basic social insurance
• Choice of insurer
• Basic benefits package
• Premiums
• Premium Subsidies (poor income, 30 of the
  population)
• More choice for patients through new healthcare
  solutions
• Risk adjustment (sex age)
• Tax finance (about 25)

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The Swiss Health Care SystemHealthcare Provision

• Primary Care (insurers patients)
• Independent practice doctors (most, no
  gatekeeper)
• Manage care models (7 doc in GP network model)
• Hospital Care (heavy subsidized by gvt)
• Hospital finance
• Pharmacy

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The Swiss Health Care SystemRevised Health
Insurance Law - 1994

• Hopes, aims expectations
• Federal Government
• Cantonal Governments
• Local authorities
• Medical associations
• Patients

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The Swiss Health Care SystemRevised Health
Insurance Law - 1994

• Hopes, aims and expectations
• Federal Government
• Cantonal Governments
• Local authorities
• Medical associations
• Patients

• reduce subsidization of health insurance
  premiums (97 of the population) by
• making subsidies targeted to individuals rather
  than groups
• requiring matching contributions from the
  cantons
• mandating cantons to draw up lists of accredited
  hospitals
• develop uniform fee schedules for physicians and
  hospitals

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The Swiss Health Care SystemRevised Health
Insurance Law - 1994

• Hopes, aims and expectations
• Federal Government
• Cantonal Governments
• Local authorities
• Medical associations
• Patients

• relieve their public purse by
• retaining authority to implement subsides to
  individuals
• retaining authority over hospital policy and
  accreditation
• fixing their share of hospital finance to 50
• develop uniform fee schedules for physicians and
  hospitals

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The Swiss Health Care SystemRevised Health
Insurance Law - 1994

• Hopes, aims and expectations
• Federal Government
• Cantonal Governments
• Local authorities
• Medical associations
• Patients

• improve the benefit-cost ratio in health care
  through
• stabilization of premiums thanks to price
  competition among insurers
• better match of coverage with their preferences
  thanks to product competition

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The Swiss Health Care SystemRevised Health
Insurance Law - 1994

• Actual situation
• Something like a status quo position
• Swiss attachment to universality guarantees an
  extremely good quality of care to all with
  limited rationing
• Costs are very high

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The Swiss Health Care SystemHealth spending
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The Swiss Health Care SystemSources of payment
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland

• CDHC characteristics
• Freeing demand (consum. buy health insurance
  plans)
• Freeing supply (insurers and providers design
  prices)
• Enhancing market efficiency
• Providing a safety net (subsidize the poor)

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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
Available Health Care Resources
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
Hospital beds, length of stay, admissions and
visits
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
Dimension Scores Problem ratings reported by
patients
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland

• Conclusion
• Swiss CDHC costs are very high
• Swiss CDHC costs reflect citizens preferences
  and resources
• Swiss CDHC system achieves 30 lower capita
  health care costs than the US system
• Swiss CDHC system guarantees universal coverage
  while providing reasonable quality of care

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The Swiss Health Care SystemUnderstanding Health
System Performance of Leading Countries
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The Swiss Health Care SystemUnderstanding Health
System Performance of Leading Countries
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The Swiss Health Care SystemUnderstanding Health
System Performance of Leading Countries
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The Swiss Health Care SystemComparison of Health
Care Systems(Australia, Canada, New Zeeland,
England and USA)
?
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The Swiss Health Care SystemConclusion -
Strengths

• Switzerland ranks first in overall health care
  system performance
• Consumer choice / control in the market of health
  care
• Price transparency of insurance plan
• Risk adjustment of insurers
• Solidarity
• No waiting time
• Competition among public and private providers
• Pervasive government regulation
• Targeted federal strategies
• Well-co-ordinated program for controlling
  communicable disease

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The Swiss Health Care SystemConclusion -
Weaknesses

• Very high costs (second highest spender on health
  care)
• Costs are still increasing
• Too long hospital stay (poor ambutory
  reimbursement )
• Medical development and possibilities
• Changing demands and expectations of the
  population
• Increased social expenditures for old age
• Co-payments for health services do not encourage
  patients to exercise restraint in their use of
  the system

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The Swiss Health Care SystemConclusion -
Challenges

• Health promotion and prevention
• Shift from disease oriented to health oriented
  society
• Favor outpatient reimbursements
• Coordination / cooperation of biomedical research
  and public health research
• Improving functioning of the market partially
  transferring administration to the federal level
• Reinforcement of competition - elimination of
  cartels - easing import restrictions
• Promotion of solidarity
• Reforms to hospital and physician payment methods
• Raising patients responsibility

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The Swiss Health Care System

• The END

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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland

• Socioeconomic characteristics that most affect
  health status
• Income
• Levels of education
• Race / ethnicity

? fair comparisons
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
Health care outcomes and expenses
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The Swiss Health Care SystemConsumer-Driven
Health Care (CDHC) Lessons from Switzerland
Potential years of life lost