What New York Times article? Aaron E. Carroll and Austin Frakt published “The Best Health Care System in the World: Which One Would You Pick?” on September 18, 2017. It featured three economists: Craig Garthwaite, Ashish Jha and Uwe Reinhardt (who has since passed). It compared the health systems in Australia, Britain, Canada, France, Germany, Singapore, Switzerland and United States. Switzerland won.
Is the Swiss system “universal”? Yes. Health insurance is “compulsory” for all Swiss citizens, which means that everyone is required by law (Federal Health Insurance Law of 1996) to buy it. Switzerland also has one health insurance system for all. It does not have separate systems for the elderly, poor and disabled, such as Medicare and Medicaid, or an employer-sponsored system of insurance like in the U.S.
How does it work? Individuals buy basic and supplemental coverage directly from health insurance carriers in the private market. Carriers are required by law to provide basic coverage to everyone (at no profit), but they can refuse to sell new supplemental coverage to an individual or exclude a pre-existing condition. They compete on price, network and service, and it’s easy to comparison shop online.
What is covered? Basic coverage, which is defined by law, includes doctors’ office visits, emergency services, maternity care, mental health, physical therapy, prescription drugs and hospitalization (semi-private room). About a third of the population also buys a supplemental plan for services not covered by basic coverage, such as a private hospital room, broader provider network and dental and vision care.
What about children? Children are covered by their parents until the age of 25. Parents can choose different carriers and plans for their children, including supplemental coverage. Some carriers offer a discount if all family members are enrolled in the same plan…similar to a cell phone company’s ‘family plan.’ The savings can be significant; for example, a 30 percent reduction in premium.
Is there a choice of insurance carriers? Yes. While things like basic benefits and carrier behavior are government regulated, the system is highly competitive among private insurers. For example, in the Davos, Switzerland neighborhood of Platz (7270), more than a dozen insurance carriers offer basic coverage at competitive prices.
How much does it cost? In addition to general taxation (municipal, cantonal and federal), individuals pay monthly premium plus 10 percent “franchise” (coinsurance) for any service. Carriers set premium based on age, features (e.g., deductible) and community. A young adult might pay $300/month and a family of four might pay $800/month for a basic plan. Low-income individuals may qualify for subsidies.
How does it compare? Switzerland spends less than the U.S. In 2015, total expenditure on health per capita was $7,536 in Switzerland and $9,507 in the U.S. The percentage of GDP on health was 12.1 percent and 16.9 percent, respectively. Switzerland spends more than other European countries, and costs are also increasing. Some people complain that health insurance is too expensive.
What else?
- Most doctors and hospitals are considered private, but some—like those affiliated with a state university—are public.
- The federal website (priminfo.ch) is easy to use (even in a foreign language!); it illustrates carriers, plans, prices and historical rate changes in French, German and Italian.
Sources: 1) Commonwealth Fund: International Health Policy; 2) OECD; http://apps.who.int. ; 3) www.priminfo.ch