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HEALTH

How is Swiss healthcare system different from the rest of Europe?

Switzerland’s health infrastructure is consistently rated among the best in the world, but how does it compare with other countries?

How is Swiss healthcare system different from the rest of Europe?
Switzerland has an efficient, though expensive, healthcare system. Photo by Hush Naidoo Jade Photography on Unsplash

Whether in terms of politics, social system or economy, the Swiss often chart their own course, which fundamentally diverges from that of its European neighbours.

Healthcare is no exception.

The differences lie primarily in who finances the scheme — public versus private — and how the overall system functions.

Like much of the European Union, Switzerland has a universal health system, which means everyone in the country is covered by insurance and has access to medical care.

In most countries, the government typically has control, to a lesser or greater extent, over funding, health insurance, and health providers.

In France, for instance, most healthcare costs are covered by the state healthcare system, known as assurance maladie, and this is funded by taxes – healthcare costs account for about 13 percent of the average person’s gross salary.

In Germany, health costs are shared by employers and workers, with employees paying 7.5 percent of their salaries into a public health insurance fund, and companies matching that amount.

Italy’s national, system, called the Servizio Sanitario Nazionale, or simply SSN, which is financed mainly though federal and regional taxes, automatically covers all residents. Medical care is largely free of charge at the point of service.

Public healthcare also exists in Austria, with certain portions of salaries being automatically deducted to fund the scheme. However, healthcare is free of charge for low-income people or those who who are disabled, studying, or retired.

Although no longer part of the EU, the UK health system is also based on state healthcare via the NHS. It is funded by taxes which account for about 4.5 percent of the average citizens’ gross income.

What about Switzerland?

The system here is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage and purchase it from one of dozens of private carriers.

Basic insurance — KVG in German and LaMal in French and Italian — is compulsory in Switzerland. It doesn’t come cheap — premiums are based on the canton of residence and age, costing 300 to 400 francs a month on average — but it is quite comprehensive; it includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

READ MORE: Everything you need to know about health insurance in Switzerland

There are no employer-sponsored or state-run insurance programmes, and the government’s only role is to ensure that all insurance companies offer the same basic coverage to everyone and that they have the same pricing.

While companies can’t compete on prices or benefits offered by the basic compulsory insurance — which are defined by the Health Ministry — they can, and do, compete on supplemental polices which offer perks not included in the basic coverage.

READ MORE: What isn’t covered by Switzerland’s compulsory health insurance?

All policies have deductibles (also called co-pays) that can range from 300 to 2,500 francs a year.

After the deductible is reached, 90 percent of all medical costs will be covered by insurance, with 10 percent being paid by the patient; however, this co-pay is capped at 700 francs a year for adults and 350 francs for children under 18.

The government does subsidise healthcare for the low-income individuals and households – defined as those for whom insurance premiums exceed 10 percent of their income.

What percentage of a person’s income goes to health insurance premiums?

This depends on wages and premiums, for instance, whether a person chose the cheapest option with a high deductible or the expensive one with a 300-franc deductible.

Generally speaking, however, based on the average monthly income of just over 7,000 francs, about 6.5 percent is spent on premiums.

What happens if you don’t take out an health insurance policy?

Anyone who arrives in  Switzerland must get insured within three months. If you don’t, the government will choose one for you and send you the bill. If this happens you may end up with more expensive premiums than you might have gotten if you shopped around yourself.

If you are still delinquent on your payments, your healthcare will be restricted to emergencies only; any other non-urgent medical treatment will be denied, unless you pay for it out of pocket.

The pros and cons of the Swiss system

Let’s look at the ‘cons’ first. Basically, there is one: the cost.

Not only are insurance premiums high and steadily increasing, but, at 7,179 francs per capita, Switzerland has the third most expensive healthcare scheme in the world — behind only the United States ($12,318) and Germany ($7,383).

Unlike taxpayer-funded models, there is no price grading according to income, so people on a low income pay a high proportion of their income for healthcare than higher earners. 

However, the system is generally efficient, has an extensive network of doctors, as well as well-equipped hospitals and clinics.

Patients are free to choose their own doctor and usually have unlimited access to specialists.

READ MORE: EXPLAINED: How to see a specialist doctor in Switzerland without a referral

Waiting lists for medical treatments are relatively short.

According to a survey by the Organisation  for Economic Cooperation and Development  (OECD) on how long patients in various countries typically wait for an appointment with a specialist, the share of people in Switzerland waiting a month or more is 23 percent, compared to 36 percent in France, 52 percent in Sweden, and 61 percent in Norway.

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HEALTH

EXPLAINED: How Switzerland wants to cut soaring healthcare costs

Swiss health costs have been rising in recent years, with further spikes, including in insurance premiums, seen as inevitable. The government is proposing measures to counter this upward trend.

EXPLAINED: How Switzerland wants to cut soaring healthcare costs

Based on the information released by Santésuisse, an umbrella group for health insurance companies, an overall increase of around 4 percent for 2023 will be the norm.

Unfortunately for the consumers, who are already hard-hit by rising energy costs, premiums for compulsory health insurance will likely rise by an average of 5 percent in the fall, according to online price comparison site, Comparis.

And many people could even see their premiums soar by more than 10 percent in 2023 — the sharpest hike in premiums in 20 years.

The exact amounts of premiums for all policyholders will be released by the end of October.

The price hikes are not a new phenomenon per se: over the past 20 years, costs have risen at twice the rate of economic growth, resulting in health insurance premiums that are 90 percent higher than in 2002.

READ MORE: How spiralling costs are jeopardising Switzerland’s healthcare system

Why have these costs been increasing so much?

Part of the reason is the fact that people in Switzerland have a high life expectancy, but as they get older, they tend to suffer from chronic, cost-intensive diseases.

The more recent hikes can be attributed to higher medical costs incurred during the two years of coronavirus pandemic, estimated to cost insurers over one billion francs so far, not even taking into account about 265 million spent for Covid vaccinations in 2021.

Add to that the cost (paid for by the government) of Covid tests, as well as booster shots administered in 2022, and those still to be given once Switzerland rolls out second doses in 2023.

How will the government cut these costs?

Santésuisse has been urging the Federal Council to implement a range of reforms to reduce costs and ensure that not so many are passed on to consumers. 

On Wednesday, authorities announced a package of measures aimed at controlling costs. “These measures will improve medical care and contain rising costs in the healthcare system”, the Federal Council said.

Coordinated networks

These care networks are seen as a way to reduce unnecessary medical services. 

“They bring together health professionals from several disciplines to provide ‘all-in-one’ medical care. They improve coordination throughout the treatment chain, for example when various specialists are caring for an elderly person with several chronic diseases”, Federal Council said in a statement.

Hospitals, pharmacies, and various therapists would be attached to the network, and all treatments “will be invoiced at once, as if it were a single supplier”.

Right now, all service providers invoice insurance carriers separately, which adds to administrative costs; the new system is also believed to provide a better oversight and control, and eliminate unnecessary or redundant medical treatments, Health Minister Alain Berset said during a press conference in Bern on Wednesday.

Faster and cheaper access to medicines

The government also wants to guarantee “fast and as inexpensive as possible access to expensive innovative medicines”.

To achieve this, it wants to “anchor in the law” an already widely-used practice: to conclude pricing agreements with pharmaceutical companies. It would mean that drug manufacturers would have to reimburse a portion of the price to insurers.

“This measure makes it possible to guarantee rapid access to these drugs, while limiting their price”, authorities said.

Electronic invoicing

Another measure will require all providers of inpatient and outpatient services to send their invoices to insurance companies in electronic form — seen as a quicker, more effective and cheaper way to transmit billing information.

These measures “will make it possible to curb the rise in costs,” the Federal Council said, adding that “it is not yet possible to estimate the concrete extent of these savings, which would depend on how the health system will implement the measures”.

It is now up to the MPs to debate these proposals.

READ MORE: Why Swiss health premiums are set to rise — and what you can do about it

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