Wednesday, December 2, 2015

Swiss Health System – Model for U.S?

Over the years, the Swiss health system has repeatedly been mentioned by commentators as a potential model for U.S.

Nikola Biller-Andorno, MD, and Thomas Zeltner, MD, “Individual Responsibilty and Community Solidarity – The Swiss Health System,” NEJM, December 3, 2015

Multiple commentators have said Switzerland is hard place not to like.

It has a 500 year history of Democracy.

It is beautiful.

It is a good place to stash money.

Its citizens like its health system.

Its average life expectancy is 83.

Its unemployment rate is 3.2%.

Its health system is market-driven and competitive and covers all.

Its people have a choice of physicians and insurers.

Its physicians do well - $185,000 for GPs and $100,000 to $388,000 for specialists.

Its politics are pragmatic and often conservative .

Its population is diverse (23.8% are non-Swiss residents),

It subsidizes 37% of premiums of low-income and middle class and covers up to 55% of their hospital bills.

And it spends only 11.4% of its GDP on health care, compared to 18% for U.S.

What’s not to like? Some complain 1/3 of its health spending comes out-of-pocket for co-pays and deductibles. And it has voted down a single payer system on multiple occasions. And there are concerns that costs are going up, that it needs a better coordinated continuum of care including social services and nursing home care, that it is experiencing physician and other health personnel shortages, that there is widespread overtreatment , and that it badly needs a better and bigger data base to judge quality and improve outcomes. In other words, as with Swiss cheese, holes exist in the system, but that seems inevitable in a country that respects choice, autonomy, and relies on individual responsibility.

Its system, it claims, does not let anybody suffer or die from lack of resources.

Would the Swiss system work in the U.S.? It’s hard to say. Switzerland has only 8 million people and lacks the regional diversity and pockets of poverty seen in the U.S. But it seems to work, as least for Switzerland.

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