is the swiss healthcare system a model for the united states? physicians for a national health...
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![Page 1: Is the Swiss Healthcare System a Model for the United States? Physicians for a National Health Program Boston, Novermber 2013 Claudia Chaufan, MD, PhD,](https://reader035.vdocuments.us/reader035/viewer/2022062421/56649da65503460f94a90f29/html5/thumbnails/1.jpg)
Is the Swiss Healthcare System a Model for the United States?
Physicians for a National Health ProgramBoston, Novermber 2013
Claudia Chaufan, MD, PhD, University of California San Francisco
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The Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employershave to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers. So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage
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‘Similarities’Switzerland
Major reform=ACA, 2010
Retains commercial insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditions
United States
Major reform=LAMal, 1996Retained commercial health insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditions
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The Illusion of SimilaritySwitzerland
Major reform=ACA, 2010
Retains commercial insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditions
United States
Major reform=LAMal, 1996Retained commercial health insurance policies Individual mandate“Affordable” plans with “essential” coverageNo discrimination on pre-existing conditions
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MANDATORY PURCHASE OF HEALTH INSURANCE
Guaranteed QualityComprehensive Coverage
Cost ContainmentSolidarity/Equality
SWISS RESIDENTS
(99.9% OF POPULATION)99.9% of population
Out of pocketpayments (1CHF=$1.08)
-Premiums vary per Canton-Deductible CHF 300/year (Mx. 2,500) -Max. co-insurance: CHR 700 /year-Hospital daily rate CHF15-No age discrimination. 26 and above= same price (Age categories: 0-18; 19-25)
MANDATORY BASIC INSURANCE PLAN
Regulated @ the national level
Covers all TX’S and DX’S prescribed by a licensed provider for both IN & OUT PT care, certain medications and medical goods, a # of hours of home & LT care, and (some) complementary TX
Supplemental Insurance
-dental, vision, private rooms (88% pop.)
$ PR
OFIT
$
Source: OECD
Review of H
ealth Systems, Sw
itzerland, 2011
Insurance Companies(80 to choose from)
NO PROFIT!!
Risk Equalization
insurance co.’s pay into the same pool
Subsidies-1/3 of pop.-50% discount of premiums for children/young adults-maternity care exempt-income-based for lower incomes
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So…what’s the problem???
Managed care plans (i.e. restricted provider networks) becoming more common (‘popular’) & insurance companies providing ‘incentives’ (e.g. lower premiums vs. higher deductibles) to sign on
Higher deductibles lead to increasing out of pocket expenses (foregone care for low-income groups); Restricted networks lead to access problems
High costs – only lower than U.S. & Norway (11.4% of GDP), including higher administrative costs due to multiple payers
Major premium price variations between cantons & regressive pricing (same for all income levels)
IN COMMON: RELIANCE ON PRIVATE FINANCING!!
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Is the ACA really “Swissified” Health Care?!....
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mandatory requirement to obtain health insuranceAffordable Care Act
Source: Kaiser Family Foundation, 2013
30 Million Leftover
Undocumented Immigrant
Opting out
Exchanges/Marketplace
Individual MandateEmployer MandateAffordable Coverage
Increased QualityReduced Costs
10 broad categories
Does not apply to all plans
? ESSENTIAL HEALTH
BENEFITSIncreasingly ‘consumer-driven’ (i.e. more out of pocket) Very poor
>65 yrsVeteran
American Indian
PUBLIC PLANS
GOVERNMENT
Employer Coverage, (FTE & business >50 people)
Subsidies < 400% FPL
Self Employed/Small Firm Employees
Low income
Middle income
High income
PUBLIC
OPTION
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The reality United States
Builds on commercial insurers, tied to employment, income or ageInsurers CAN MAKE PROFIT from medically necessary coverage (skimpy & no national standard)RESTRICTED PROVIDER NETWORKS (‘PREFERRED PROVIDERS’) IS THE NORMVERY FEW COMPARATIVE SHOPPRICE CONTROLS ANATHEMA! Service A can sell at whatever price!Financially fragmented – ‘profitable’ patients in private plans, ‘unprofitable’ in public plans (increasingly privatized)Price discrimination by age. EXCLUDES UNDOCUMENTED IMMIGRANTS, VERY POOR (‘HARDSHIP EXCEMPTIONS!)
Switzerland
Builds on long history of social insurance – coverage no longer tied to employment, income or ageInsurers CANNOT MAKE PROFIT from medically necessary coverage (very generous & national standard)All insurers must offer plans THAT INCLUDE ALL PROVIDERS EVERYBODY CAN COMPARATIVE SHOP (even if most do not!)PRICE CONTROLS! (same service, same price)Large pool overseen by government -- risk equalization, healthy/sick same poolNo price discrimination by age, immigration status, etc.
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Conclusions
• The ACA is NOT a ‘version’ of LaMAL – doesn’t “turn US into Switzerland” (Paul Krugman)
• LaMAL has problems – may even not be working for the Swiss
• The fallacious debate and spin obscure real problems and undermine search for real solution
• If the goal is universal, equitable health care, we need a real National Health Plan
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What to do?
• Educate ourselves, family, friends
• Join the single payer Medicare for All movement
• Connect the dots (with other public policy issues – war-making)
• Demonstrate!
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Thank you!
My appreciation to my colleagues atPhysicians for a National Health Program, for their years of struggle to achieve health care equity for the American people