Health care in Switzerland
The Swiss healthcare system regulates the relationships in the healthcare system between insurance companies, insured persons, service providers and other groups involved in Switzerland . It is typical of Switzerland and, for historical reasons, it is consistently federalist .
Insurance
illness
Since 1996, every resident in Switzerland (i.e. locals and foreigners entitled to reside) has been insured for treatment costs in the event of illness ( Health Insurance Act , KVG).
The insured person is responsible for paying the health insurance premium , which is not dependent on income and assets, but is determined by the respective health insurance company as a cap premium depending on the region. However, this is subject to approval by the Federal Office of Public Health . The 2007 monthly premium for adults aged 26 and over was an average of 313 Swiss francs (extreme: Canton Nidwalden 216 CHF, Canton Geneva 423 CHF). Since its introduction, the monthly premium has increased significantly each year, most recently by an average of 9.9 percent in 2010, and an increase of seven to ten percent is planned for 2011. With individual premium reductions based on the taxable household income, the lower income groups and large families can be relieved. The relevant regulations differ between the cantons and are financed from general tax revenues. In 2009, almost 2.3 million people (29.6% of the population) received subsidies for their contributions.
The health insurance companies are private companies; there is no state health insurance company . However, every health insurance company is legally obliged to include everyone in the basic insurance who makes a corresponding application and is domiciled in the area of activity of the health insurance company. The resulting competitive disadvantage of health insurers that have more older and / or sick members is only partially offset with a special fund ( risk compensation ). For (voluntary) additional insurance (i.e. all benefits that go beyond the statutory basic insurance), however, the health insurers are free to decide which contracts they want to conclude with whom. You can freely set the premiums and reject interested parties.
The state hospitals are financed on the one hand by paying for treatments (patients, insurance) and on the other hand by subsidies from the cantons or municipalities. Because of this partial cantonal financing, all state hospitals charge lower taxes from residents of the siting canton than from non-residents. Because of these different costs, the statutory basic insurance only covers treatment in the general ward in a hospital in the canton of residence . (Exceptions apply in emergencies and where a certain service is not offered in the canton of residence, such as cardiac surgery or neurosurgery , which is limited to centers). Private hospitals, on the other hand, are usually only financed from treatment fees, which are therefore significantly higher than those in the general departments of state hospitals. The statutory basic insurance therefore does not cover treatment in private clinics.
In addition to the compulsory basic insurance, there is also voluntary supplementary insurance, with which the insurer can grade the premiums according to the individual risk of the insured. In contrast to the basic insurance, the health insurer can refuse to accept additional insurance.
There are contracts with the EU states that regulate the mutual assumption of treatment costs in emergencies. All EU insured persons must for treatment in a state of the European Economic Area - i. H. the European Union, Norway , Iceland and Liechtenstein - and in Switzerland, present the European health insurance card or a provisional replacement certificate.
Accidents
Every employee is compulsorily insured for treatment costs in the event of accidents ( Accident Insurance Act, UVG). On the one hand, there is an independent accident insurance under public law ( Schweizerische Unfallversicherungsanstalt , SUVA), on the other hand, most private insurance groups also offer accident insurance according to UVG. It is up to the employer to insure all employees, although, depending on the workload, only accidents during work or accidents during leisure time must be insured. The premiums for occupational accidents are only borne by the employer. In contrast, the premiums for leisure accidents are borne by the employee. If you are not employed and do not want private accident insurance, you can get additional accident insurance from your health insurance company.
In Switzerland, the accident insurance premium is deducted directly from the salary for employees and the amount depends on the salary. The percentage depends on the industry.
dentist
With a few exceptions, dental treatments are not included in the catalog of services provided by the compulsory basic insurance. It is possible to take out dental care insurance privately. However, due to the high price, this option is rarely used. Most dental costs are accordingly paid out of pocket by the patient.
costs
Rates
The prices of medical treatments are strictly regulated. On January 1, 2004, a tariff system ( Tarmed ) that applies throughout Switzerland was introduced, which assigns a certain number of "tax points" to every medical service. This would theoretically mean that medical bills would be the same throughout Switzerland. However, the tax point value was set differently depending on the canton, so that the same treatment can be different from canton to canton. These differences are justified by the different incomes, cost structures, doctor densities and mentalities in the cantons.
In addition, on January 1, 2012, the SwissDRG case flat rate system and the associated new hospital financing were introduced in Switzerland .
costs
| power | Costs in CHF million (2015) |
|---|---|
| Inpatient curative treatment | 15,385 |
| Outpatient curative treatment | 20,916 |
| rehabilitation | 3,398 |
| Long term care | 15,128 |
| Support services | 5'490 |
| Health goods | 12,628 |
| Prevention | 1,873 |
| administration | 2,937 |
The Federal Statistical Office publishes data on health costs every year. The time series exists for the years from 1985 onwards. The total costs for 2015 are estimated at 77,754 million Swiss francs, which corresponds to a ratio of 11.9 percent to GDP .
According to OECD figures , in 2013 Switzerland had the third highest health expenditure in the world in terms of GDP.
Cost development
As in most western countries, in Switzerland too, the cost development in the healthcare system is a constant topic with new ideas on how to bring about a turnaround. The reasons for this increase are the subject of heated debate. Progress, aging, underdeveloped prevention, inadequate quality assurance, federalism ("26 health care"), lack of coordination, wrong financial incentives, the power of interest groups, commercialization, the increased expectations of consumers and service providers, high levels of medical and health care Dentist income, the direct sale of drugs to patients in individual cantons in Switzerland (“self-dispensation”), the “arms race” among hospitals in competition, drug prices that are too high, generic drug use too low , doctors and hospitals too high - and device density as well as unnecessary operations, examinations, medication, doctor visits and long hospital stays. In addition, according to many international comparisons, the level of health expenditure also depends heavily on the country's prosperity (measured e.g. by GDP per inhabitant).
Austerity measures
So far, the political countermeasures have mainly concentrated on patients (higher cost sharing ), hospitals, independent practitioners and the pharmaceutical industry.
Other measures discussed are the lifting of the compulsory contract (insurance companies should be given the opportunity to selectively conclude contracts with doctors), the promotion of HMOs (Health Maintenance Organizations), family doctor models and group practices , the introduction of a standard health insurance instead of around 90 health insurers, an age limit for practitioners Doctors, stricter licensing regulations, quality certification and the abolition or restriction of so-called self-dispensation (direct sale of drugs by independent doctors, as is still permitted in some of the cantons in Switzerland). In addition, there is an increase in the deductible and the deductible on the patient side, as well as a reduction in the basic service catalog (mandatory services of health insurers). Hospital financing systems are also being introduced, which are intended to contain costs ( flat-rate per case / DRG ). When it comes to drugs, the focus is on promoting generics and approving parallel imports. Mail order pharmacies and multiple pharmacies are also permitted in Switzerland. Dentistry (which is not financed by social health insurance) is hardly affected by austerity measures .
Drug delivery
In Switzerland, the pharmacy sector is kantonal regulated. This circumstance allows the Europe-wide peculiarity that under certain conditions the doctors are equal to the pharmacists when dispensing medication without proof of additional training. Art. 37 para. 3 KVG requires the cantons to set conditions under which doctors are on an equal footing with pharmacists when dispensing drugs directly to patients without proof of additional qualification, and that this regulation takes into account the patients' access to a pharmacy are. Due to Swiss federalism, each canton has interpreted Article 37 of the Health Insurance Act differently. In 14 cantons (AI, AR, BL, GL, LU, NW, OW, SG, SO, SZ, TG, UR, ZG, ZH) doctors are allowed to sell drugs directly to patients without prior examination by a pharmacist. In 9 cantons (AG, BS, FR, GE, JU, NE, TI, VD, VS) this so-called self-dispensation (SD) is generally prohibited. Mixed forms can be found in the other 3 cantons (BE, GR, SH).
maintenance
See also
literature
- Willy Oggier (Ed.): Healthcare Switzerland 2015-2017 - A current overview. Hogrefe Verlag, Bern 2015, 488 pp., 85 figs., 129 tabs., 5th edition 2015, ISBN 978-3-456-85441-0 (e-book ISBN (PDF) 978-3-456-95441 -7).
- Health Insurance and Healthcare - What Next? (Ed. Daniel Biedermann et al.). Verlag Hans Huber, Bern 1999, 237 pp. ISBN 3-456-83203-6 .
- Panorama Health - Switzerland in a European comparison. Swiss Health Observatory obsan, Neuchâtel 2003.
Web links
- Federal Office of Public Health
- Sebastian Brändli: Healthcare. In: Historical Lexicon of Switzerland .
- Swiss Health Observatory obsan
- Swiss Society for Health Policy SGGP
Individual evidence
- ↑ C. Rüefli, M. Duetz, M. Jordi, & S. Spycher: health policy . In: W. Oggier (Ed.): Healthcare Switzerland 2015–2017 . Hogrefe, Bern 2015, p. 117-122 .
- ↑ Claudia Schoch: Health insurance premiums will rise in 2011 by 7 to 10 percent. Neue Zürcher Zeitung , May 6, 2010, accessed on May 20, 2018 .
- ↑ The Swiss are extremely unhappy with their flat rate per capita. Doctors newspaper, December 22, 2009, accessed May 20, 2018 .
- ↑ costs. Federal Statistical Office, accessed on May 20, 2018 .
- ↑ Costs and Financing . In: Federal Statistical Office (ed.): Health - Pocket Statistics 2017 . FSO, Neuchâtel 2018, p. 38 .
- ↑ How high are health expenditures in Germany . In: OECD (Ed.): OECD Health Statistics 2015 . 2015, p. 2 .