Comments on: Swiss Health Care: The Good, the Bad and the Ugly

By: K.L.Woody

K.L.Woody — Sat, 17 Jul 2010 02:49:26 +0000

Now that ‘Obamacare’ has passed I’m scared to death. I suffer from a cronic illness and 1 of my 4 medications has already gone through the roof. Five months before the plan was passed my cost went from $72.00 to $475.00. I’m scared to death to stay in America and am studying other countries to move to. I have friend’s and relatives in Sweden but that system is very broken. It is hard to emigrate to Switzerland from what I understand. They want the very wealthy.

By: HD Carroll

HD Carroll — Wed, 21 Oct 2009 18:24:24 +0000

The US does not have an extensive market for reinsurance in the Medical Expense arena because most of the commercial business is in the hands of the BUCAHs that do not reinsure at all. Yes, there is a bit, but it is tiny compared with the Life and P&C insurance markets, and most of what passes for “reinsurance” in the medical area is restricted to stop-loss on self-funded contracts, which is not immaterial, but still a small drop in the bucket. There might very well be plenty of capacity available if appropriate use of reinsurance as the chosen mechanism for “risk adjustment” were used to pool certain levels and kinds of claims in an environment where insurers could no longer underwrite for medical status or apply limits on pre-existing conditions. Such an environment would still require the necessary incentives for “healthy” people to buy insurance early in life rather than wait till they are older and/or sicker. The Swiss health system uses the pool to spread the risk that a particular insurer picks up an irregularly high number of expensive insureds than expected, but this can of course be exacerbated by some of the companies effectively “redlining” in the marketplace, which an earlier responder mentioned continues to be a problem, though probably not a major one.

By: Linda Gorman

Linda Gorman — Tue, 20 Oct 2009 17:24:08 +0000

The US has an extensive market for reinsurance so a reference outlining the functional differences between Swiss reinsurance and US reinsurance would be most helpful.

Care must be taken in comparing costs across countries. Due to price controls on health care providers and vastly different accounting systems, international comparisons often use cost data that compare apples and oranges.

By: Stan I.

Stan I. — Tue, 20 Oct 2009 13:36:51 +0000

John, Left or right is not the issue really and many health care students study the Swiss System. It is a interesting blend of government levels and insurance companies. . May be too many insurance companies perhaps to be efficient. Most Cantons have strong public hospital system .. similar to Parkland .. where the public.. middle class, etc all go to this quality public facility . Often as I remember , a university is often linked to these facilities. Also Reinsurance for insurance companies is neat concept in Swiss system. This how they handle expense conditions , like renal care.

For 7 million or so .. with 98% coverage, the Swiss keep costs down compared to USA System as I recall fairly well.

Renal care is interesting. Even though they have an older population, the average of age of their renal dialysis patient is ten years younger as I recall. Swiss physicians often believe we have cowboy physicians who treat too many older serious ill patients, because of economic incentives. Renal care in Swiss is mostly outside the profit motive system . A physician friend of mind has introduced new German treatment system that costs 1/3 of typical renal dialysis system in his hospital. His guess is that it will never be introduced here because the hospitals , physicians and insurance companies will not see the high levels of reimbursement that they now see with this new system. What do you think John?

By: Congressman Michael Burgess

Congressman Michael Burgess — Tue, 20 Oct 2009 13:33:22 +0000

You may inform your readers that at least 1 Member of Congress read your post.

By: John R. Graham

John R. Graham — Mon, 19 Oct 2009 22:19:33 +0000

With great respect to Prof. Herzlinger, I think that she was a little too enthusiastic about the “re-insurance” element of the Swiss health-insurance system, which (in my words) relies on a cartel of the government and the health insurers to decide how much each medical condition is “worth”. Although I hate to commend the Commonwealth Fund here at the John Goodman blog, it did commission a nice paper from some Dutch and Swiss health economists [R.E. Leu, et al., The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets, pub. no. 1220 (New York, NY: The Commonwealth Fund, January 2009], in which the Swiss economists concluded that risk selection still occurs there, i.e., that despite risk-adjusted re-insurance, health insurers are able to earn more money by enrolling healthy people (p. 15). If we reject centralized price fixing for health goods and services, I don’t see why we would think that centralized price fixing for risk would be an improvement. As Prof. John Cochrane has demonstrated (via health-status insurance), the market would be able to price risk quite well if the government allowed it to.

By: Bart Ingles

Bart Ingles — Mon, 19 Oct 2009 20:56:58 +0000

Why not simply require 3rd party price lists to be out in the open? This would address the anti-competitive nature of 3rd party pricing, preserve flexibility for private two-party transactions, and give individuals a bit of guidance as they attempt to negotiate terms for direct purchase of services. Not everyone understands that they can negotiate with a hospital, let alone how or for what price. To be honest, I’m not sure I’d be able to.

By: Linda Gorman

Linda Gorman — Mon, 19 Oct 2009 20:51:01 +0000

Why should a provider charge every patient the same amount? Historically about a third of the care individual physicians provided was free or reduced cost. That was how they did charity care. It worked, because they knew the people involved.

There is nothing transparent about the prices for the other services we buy in market economies. They seem to do just fine without transparency regulations. I would suggest instead that the problem is third party payment. RVRBS is Marx’s labor theory of value reincarnated by Medicare from the ash heap of history–it does a lousy job of substituting for the information contained in a honest to goodness price.

By: bblsu63

bblsu63 — Mon, 19 Oct 2009 19:48:57 +0000

How can you compare nationally insuring the population of a country (Switzerland) with 7.5 million people with the complexities of “fully” insuring 306 million people(USA)? Last I heard 80-90% of the citizenry in the USA were relatively happy with what we have. How about fixing what we have with the free enterprise system we have????

By the way Cuba has about 11 million and Canada about 33 million people.

By: Wendy

Wendy — Mon, 19 Oct 2009 19:25:43 +0000

I have a Swiss friend who is studying in the States. She has had serious sinus problems for years. While on a visit with her in Switzerland she had a flare-up. Her doctor, also her good friend, prescribed head-ache powder and gave her sleeping medication. This was the extent of her solution! I was livid because the symptoms were clear and her doctor did not refer her to a specialist or discuss further treatment. Also, her insurance dropped the level of her coverage to major medical because her condition was costly to them. Since then, she has had treatment and surgery in the U.S. and has said that she her faith in the Swiss system has been severly shaken.