HEALTHCARE IN SWITZERLAND

HEALTHCARE IN SWITZERLAND

By:Benazir Alam; Dipmala Saha; Kumari Moushmi; Nuzhat Fatema; Parul Lathwal; Priya Mahajan; Riya Roy; Sonal jain

COUNTRY PROFILEPopulation :- 7,925,517 Birth rate :- 10.4 births/1000populationDeath rate :- 8.1 deaths/1000 populationCapital :- BernSex ratio :- 0.97males/femaleInfant mortality rate :- 3.9 deaths/ 1000 live birthsTotal fertility rate :- 1.53 children born/womenMaternal mortality rate :- 8 deaths/100000 live birthsEthnic group :- German

Major religion :- Roman, Catholic and ProtestantLanguage :- German ,French, ItalianLiteracy :- 99%Education expenditure :- 5.2% of GDPHeath expenditure :- 11.3 % of GDP (2009)Physician density :- 4.07 physician/ 1000 populationHospital bed density :- 5.31 beds/ 1000 populationLife expectancy :- 81.17 years

Introduction

The current Swiss healthcare system came into effect in 1996 under the Health Insurance Law (LAMal) of 18 March 1994, which sought to introduce a perfect managed competition scheme across Switzerland, with full coverage.

Both Uphold the principles of universality and equality by mandating.

The Swiss system is highly decentralized, meaning that the 26 Swiss cantons are largely responsible for the provision of health care and insurance companies operate primarily on regional basis.

There are few uninsured (about 1.5% of the population) and is regulated by the Swiss Federal Law on Health Insurance.

The health-care delivery system is a mixed system.

Health insurance is compulsory for all persons residing in Switzerland(within three months of taking up residence or being born in the country), which sought to introduce a perfect managed competition scheme across Switzerland, with full coverage in basic health insurance.

The health insurance law enlarged the package of statutory health insurance to basic package defined by the Swiss federal government.

The idea behind this new law that was compulsory was to define the level of healthcare the patients may expect as given but also allow competition between insurers to drive the standards and drive the cost of insurance premium.In order to avoid discrimination insurers must accept all applicants (open enrolment) and cannot vary premiums based on the health of each consumer; nor can they make a profit on basic package plans.

International civil servants, members of permanent missions and their family members are exempted from compulsory health insurance. Request for exemptions are handled by the respective cantonal authority and have to be addressed to them directly.

OECD figures suggest that 65.2 % of health spending in Switzerland is public, somewhat below OECD average of 72.2%, demonstrating that relatively large proportion of private spending.

The basic packageThe basic package is restricted to medical treatment deemed appropriate, medically effective and cost effective.

Individuals can seek treatment in their canton of residency.

The basic package is divided into three categories: 1- Sickness Insurance2- Maternity Insurance3- Accident Insurance Examples of Coverage include:

Hospital Stay and outpatient care in any general ward of the canton of residency. Nursing care, of up to 60 hours per week at home or in a nursing home. Examination, treatment and nursing in a patients home by a physician or chiropractor. Rehabilitation ordered by a physician, including health resorts. Physiotherapy and ergo therapy (max. 9 sessions). Nutritionist/diabetic consultation (max 6 sessions). Emergency treated abroad . Transportation and rescue cost (50% of emergency transport cost up to CHF5,000 per year and 50% of non life threatening transport up to CHF 500 per year. Maternity costs, including 7 routine examinations, post-natal examination, childbirth and 3 breast feeding consultations. Serious and inevitable dental treatment. Legal abortion . Cont Universal CoverageUniversal coverage: An essential add on that guarantees that vulnerable groups get the treatment needed.

All individuals must purchase a basic package insurance plan or face a penalty.

Insurers must charge the same price to every individual that buys a particular health care plan.ContContPrivate Insurance CompaniesPremiums Since companies are allowed to compete on price-there is a differing cost of health insurance within and between each of the Cantons.

An example of this : In 2001 premiums ranged from $119 per month for high-deductibles, to $159 for a managed care plan and $199 per month for low-deductibles.

However, in 2005 it was found that the difference between the lowest and highest premiums with a 300 CHF deductible was 89% in the Zurich area.

This suggests that factors other than deductibles are affecting the price of plans and many believe that it is in fact predominantly the result of a poor risk equalization system. (Source: civitas.org.uk)ContPvt. Insurance CompanyNo claims bonus scheme: A rule discourages overuse of services.

Individuals that do not submit claims receive an increasing reduction in their premium each year.

After 5 years this can reach 45% a clear incentive to adopt healthier life styles.Supplementary Insurance

1. HMO (Health Maintenance Organization): In the Swiss context, the term HMO applies only to a group of physicians who practice in a unified organization. HMO personnel always include primary care physicians, and may also include specialist physicians as well as non-physician health care workers. However, Swiss HMO (and PPO) networks do not include hospitals, because by law, CBSI coverage is limited to public hospitals or listed private hospitals, both of which are heavily regulated by the cantons.MODELS

In some cases, HMOs are owned by the health insurer, in other cases, they are owned by the doctors themselves. Doctors may be paid a salary or a fixed monthly fee per patient (capitation). The Swiss PPO maintains a physician list and only covers the cost of care from providers on its list.2. Telmed: With Telmed policies insurer first need to ring a telephone counselling service before seeing a doctor for illness. Cont.

The call centre is manned by medical professionals who will give information and recommendations for particular health problem. Whenever necessary he will be referred to a doctor, a hospital or a therapist. This telephone advice line saves money so that insurer can pay lower premiums.

3. Increasing the annual excess Sometimes the health insurance companies offer the opportunity to increase the excess. If insurer chooses an excess higher than CHF 300, he contributes more to the costs. So he pays a lower premium. Cont.

4. Join a bonus insurance program: Premium is reduced gradually for every year that insure does not submit any invoices to the health insurance fund for reimbursement. The starting premium is 10 percent higher than the standard premium. It can then fall to 50 percent of the starting premium within 5 years.

5. Disability insurance: Disability is when the physical or mental health of a person is affected to such an extent that he cannot work or can only work part time over a fairly long period. Cont6. Old Age Pension & Survivors Benefits Scheme:Old age pension or benefits in the event of the death of a spouse or a parent are paid out by the Old Age Pension & Survivors Benefits Scheme.7. Accidental insurance: In Switzerland all employees are automatically insured for work-related accidents. Anyone who is in employment for more than eight hours a week is also insured for non-work-related accidents. The accident insurance is paid jointly by the employer and the employee. Insurers contribution is deducted from his salary. Cont

8. Long term care is not a part of social insurance and is still paid largely privately out of pocket.

9. The Swiss also have a Family Doctor managed care model in which the individual signs up with a gatekeeper doctor chosen from a list maintained by the insurer. In this case, the gatekeeper is in independent practice and is paid on a fee-for-service basis by the health insurer. Cont

Hospitals, which can be public, private non-profit or private for profit receive about a third of their financing from the cantons, within a cantonal planning system. Hospitals are paid by insurers either on a per diem(per day) or a DRG Diagnosis Related Groups basis negotiated at the cantonal level. As of 2012, hospitals are to be reimbursed on a nationwide DRG basis.The cantonal governments absorb hospital deficits.Payment Of Hospitals In SwitzerlandPayment Of Physicians In Switzerland Switzerland has one of the highest physician-population ratios. Hospital-based physicians are usually salaried.

Ambulatory-care physicians are paid on a FFS(payment is dependent on the quantity of care, rather than quality of care) basis at fees that are negotiated on the cantonal level between associations of insurers and of physicians. Swiss CBSI policies are subject to community rating.Community rating means that each insurer must charge all enrolees in a specific plan in a given geographic region the same premium, regardless of health status or health risk (with some carefully defined exceptions for those below the age of twenty-five). Community rating Swiss CBSI policies are subject to guaranteed issue. Guaranteed issue means that insurers may not deny coverage on the basis of health status or risk.

Swiss supplemental coverage, however, is subject to neither community rating nor guaranteed issue.

Premiums for both types of products are set by insurers, although CBSI premiums are subject to governmental review. Guaranteed Issue We agree that the expansion of public coverage is the only way to ameliorate the condition of the poor and working classes.

The Swiss present everyone, rich or poor, with the same menu of choices among competing health insurers, while their system of subsidies makes coverage reasonably affordable for everyone. Conclusion References

[1] B. Dormont, P. Geoffard, and K. Lamiraud, The influence of supplementary health insurance on switching behaviour: evidence on Swiss data, Institute of health economics and management, Working paper no. 07-02, Lausanne, p2, May 2007. [2] OECD and WHO survey of Switzerlands health system, Press Release, 19.10.06,www.euro.who.int .[3] FOPH website- www.bag.admin.ch, [Viewed on 23.11.07] .[4] OECD and WHO survey of Switzerlands health system, Press Release, 19.10.06,www.euro.who.int, [Viewed on 22.11.07] .[5] Holly, A, Gardiol, L, Eggli, Y, Yalcin, T, Ribeiro, T, Health based risk-adjustment in Switzerland: and exploration using medical information from priori hospitalisation, National Research Program 45 Future Problems of the Welfare State, Lausanne, Switzerland, 2004, p8 .[6] Hertzlinger and Parsa-Parsi, Consumer-Driven Health Care: Lessons from Switzerland, JAMA, Vol.292, No.10, 2004 .[7] Statistics from FOPH website. http://www.bag.admin.ch/themen/krankenversicherung/01156/index.html?lang=ene

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