Swiss Health Carea time for reassessment

Dr Alphonse CrespoWorkshps on Health InsuranceBeijing 2008

Basic Principles

GUARANTY OF ACCESS

GOVERNEMENT SUBSIDIARITY

REGIONAL AUTONOMY

INSURANCE BASED 

 INDIVIDUAL RESPONSIBILITY  

                        PRIVATE PROVIDERS 

Who pays?

11.6% of GDP IS INVESTED IN HEALTH CARE

30% out of pocket25% public subsidies35% social insurance10% private insurance

Health Consumer Satisfaction

The European Scene

European Health Consumer Index:

Insurance based systems

Do better than

National Healthcare Services

Reforms

After 1994

Mandatory insuranceCartel Dominated modelCost containment oriented

Subsidies target indlviduals

More federal regulatory power

Until 1994

Voluntary insurance*

Private & subsidized providers

Wide Cantonal autonomy

Swiss Hospitals

230 public hospitals3.5 beds per 1000 inhabitants

136 private hospitals (mostly in bigger cities)0.7 beds per 1000 inhabitants AN EXPANDING SECTOR

±30% of global health expenses

PRIVATE HOSPITAL SECTOR

Private Hospitals

Open to patients with supplementary insurance

Some exceptions for ambulatory treatment

Public hospitals

Offer private wards

Swiss Hospitals - dual financing

Public hospitals financed through:State subsidy: 55% - Insurance : 45%(Out-patients: insurance + copayments)

As from 2009-2012:

• No public subsidies for investments & hardware • No public cover for deficits• Diagnostic related based (DRG) reimbursement• List of approved hospitals (including private)• More trans-cantonal access• More federal planning of hospitals

Effects of cost containment

Reduction of global number of public Hospitals

• Mergers of local or regional hospitals• Centralization of specialty units• Shift of care to larger cantonal or University Hospitals• Incentives for in & out surgery

Restriction of doctor practices

Effects of centralization?

How Safe is Big ?

Comparis Study on Swiss Public Hospital Outcomes and critical incidents - Aug. 2007

Public dissatisfaction :

Clear Signals

March 2007: Vote on Single National Insurance Provider

72% NO June 2008:

Regulation of doctor offer

69.5% NO

European models conceived in 19thC not adapted to challenges of the 21st C

Basic Concept for reform

RISK PROBABILITY POVERTY

need specific approaches

Sustainable health care

Covering for RISK

Mandatory Health “Insurance”

First dollar coverage or low deductibles: Covers risks AND certaintYProvides for minor ailments

= Overuse & wasteHigh premiums

Rationing

Market based Catastrophic Insurance

High deductibles & co-payments =

Cost-consciousnessIndividual responsibilityAffordable premiums

Providing for PREDICTABILITY

Health Savings Accounts

• Adapted to chrono-physiology of health

• Avoid inter-generational gridlocks

• Allow for more transparency & consumer pressures on prices

• Create capital

Health Savings Accounts

From1984:

SINGAPORE Medisave : 84% of Population(+ Social insurance for high risk)

South Africa (+ Private Insurance)1994 Covers 5% of Population

USA (+ HDHP)1997- 2002 Test phase 2003 - 2006 Integrated to law

China ?Urban pilot experiments since 1994

Caring for POVERTY

The pillars of sustainable health care

Health Savings Accountsfor predictable health

expenditures

Risk insurance & pooling for catastrophic health

expenditures

++ Micro-insurance

Philanthropic initiatives--

Health vouchersPublic Social Services

for the needy

+ +

+THANK YOU FOR YOUR ATTENTION