Compulsory health insurers are non-profit. Insurers can only make profits with private insurances on top. See Key points in brief
There are still insurance admin/management costs that may be higher with the current model. I don’t know whether a single insurer model would be cheaper overall.
Other parts of healthcare are profit-oriented, of course, but to a certain degree this is the case everywhere (at least for some pharma). Maybe there are parts where stricter regulations or nationalization would help. I don’t know.
I agree that transparency is definitely an issue. E.g. I think it’s terrible that patients don’t automatically get (itemized) bills in all cases. Some bills go straight to the insurance without the patient knowing any details and thus, not being able to check that the bill is correct (as far as possible without medical knowledge).
Personally, having lived in several countries with government health insurance, I lean towards the private, competitive system currently used in Switzerland.
If we look at real examples of private vs. government insurance in Switzerland, we see a certain pattern:
Swiss social security could be a possible point of reference. In almost every case, private social security offices (those serving industry associations, for example) have substantially lower administrative fees than government social security offices.
The OASI, which is the closest thing to a government-run insurance in Switzerland, needs constant injections of taxpayer money (e.g. VAT) in order to exist. It has not been able to function viably, much less profitably.
My experience in countries with government-run health insurance schemes is that health insurance premiums end up at least as high (just look at Germany), while coverage and service are generally poor. In almost every case, additional injections of taxpayer money end up being needed in order to keep these schemes affloat, and a large part of the healthcare infrastructure ends up being funded by taxes instead (hence the seemingly-low healthcare spending).
For example, my brother-in-law in Sweden had to wait two years for a simple diagnosis and operation (kidney-stone). For a full year of that time, he was in too much pain to work, and lost out on a full year of income. In contrast, a co-worker of mine here had a kidney stone, and was diagnosed and operated within 1 week! P.s. Did I mention that my brother-in-law hands over 30-40% of his salary to the Swedish government for things like healthcare?
This is just my opinion and experience. I am sure that there is a better way to do things. Raising the deductible to a minimum of 2500 francs and cutting out coverages which make a limited or doubtful contribution to public health would be good first steps, in my opinion. But for the moment, the cost-to-benefit ratio of Swiss health insurance is rather good, all things considered.
Health insurers make regular controls among physicians by looking at their billing habits compared to colleagues with similar patients (age, morbidity factors, etc.). When someone is above a certain level say 120% he/she receives a warning. It can lead to a situation where the physician is forced to make a refund. When they cannot agree it goes to the court. In other cases a theroetical maximal salary is calculated and the billed revenue above has to be refund. See for example Décisions | Chambre des assurances sociales de la Cour de justice Cour de droit public (ge.ch)
I agree however that the current medical tariff TARMED (pay-to-service) creates a strong incentive to over-bill and that it should be replaced by a more all-in-package tariff, as it is the case in the hospital sector (swissDRG).
Another issue of our system is also that both hospital and non-hospital care and differently financed, the former being financed 45% by the KVG, the latter 100%. Hence if treatments such as small surgeries goes from hospital to non-hospital care, although it might be less costly, it will drive the KVG expenses up…
Swedes apparently have serious issues with their system with long waiting times, hospitals refusing to treat you if you are not in your home region (happened to a friend who broke a bone while skiing at a resort 8 hours drive away from their regional hospital), etc.
Doctors seem to like it though: I have heard a few saying that it’s much more relaxed to work in Sweden because doctors have shorter workdays. From the book “Why we sleep” I learned that rest time (sleep, actually) is crucial for doctors to do a good job, a large number of deaths being attributable to overworked doctors (especially while in residence) in the US.
You guys are playing “their” game. As long as we waste time discussing single vs. multiplej insurers, we don’t discuss the real problem. (which has alreadyy been mentioned from some of you)
The single insurer will let you save maybe max 10%, I don’t remember the exact number, but it’s laughable. This is also true iif you just ask the insurers how much is their internal costs. It doesn’t mean that once there is one single insurer, things will not degrade.
So, imho, we shoudl stop discussing this topic and switch to the real topic of the costs.
Also transparency is b.s. You get a bill with some silly info, what could you do about that? Ofc most of the doctors don’t lie, they just itemize anything, probably even washing their hands etc…
I can’t agree more. In my opinion, the real topic that needs discussion is a shift from the current “healthcare plan” model to an actual “health insurance” model (i.e. an insurance which covers unforeseen risks, not routine healthcare).
Personally, I find Singapore’s model interesting. There, a contribution from your salary goes into your blocked personal healthcare account. This account is drawn on to cover healthcare. Of course, it does not adequately cover the cost of serious illness, and once it has been depleted, public subsidies take over. But it does send the clear signal that primary responsibility for your health rests with you.
Vaccination (esp. for travel) is not an exact science. Some doctors are more conservative than others. Maybe you both come across very different (one willing to take a (minimal) risk, the other very anxious about everything).
I recommend a great resource like CDC website to allow oneself to make own travel vaccination choices.
I was about to disagree but I’ve finished reading it and noticed a very big important word: “responsibility (for your health)”.
This is an important idea that could be added to the mix.
BUT… big but(t)… I’m 99% confident that my profession is less risky that a gardener, at least from the point of view of health insurance, so somehow we can’t really talk only about responsibility.
(Please don’t start a new discussion about the real health risks of professions. I know I know… my boss should pay me yoga for my back or a better desk and also my glasses and so on… Talking about a pandora’s box)
Probably I was not very explicit. I got A B C D vaccines, wife got A B.
Remember my doc opening book/guide to check what’s needed for the region, ie spending some extra time. Can’t tell what wife’s doc did or if there more consultation time billed, but since we both have no condition, there shouldn’t be.
My bill was 160, wife’s 290. After challenging wife’s bill it was reduced no questions asked.
For me that just show how much freedom they have to bill you whatever. Now imagine what they can put under less trivial (un)necessary tests, consultation and etc.
I think in Switzerland, the easiest way to do this would be to raise the minimum deductible to 2500 francs. The actual cost-difference for policyholders would be minimal (compared to paying higher premiums for a 300-franc deductible), but I’m convinced that the psychological impact would result in much less unnnecessary healthcare usage. Those who want extras can get supplemental insurance which isn’t subsidized by all residents.
Am I correct in guessing that you challenged this indiscrepancy because you had to pay it out of your own pocket as your deductible? The vast majority of people do not challenge this kind of thing when it’s being paid by insurance.
That’s another reason why a higher deductible would probably lead to lower healthcare costs, as consumers are far more likely to challenge absurd bills when they are paying them out of their own pockets.
adjusted for the difference in premiums, it’s about 750.- (different for each canton, age etc.), i think. so, question for the individual ‘unable’ to pay for it, is: a) didn’t plan for it or b) not enough money (could probably be handled via prime reduction system?).
Kidney stones are not like broken bones… Some kidney stones are easily diagnosed, other take time. Without knowing the background like age, presenting symptoms, family history etc. there is no way to compare your BIL and your co-workers story.
It won’t work. We will see just more emergencies. Or maybe just slightly more? Some people will just complainn, some other might get more sick.
Maybe the real solution is to have a summary at the end of the day and give bonus point to the healthy AND to the rightly unhealthy. The rest will get a malus and pay more health insurance the next year. Be ready for abuse.
This is a good point to check. Is the problem “unnecessary usage” (I go to the doctor because my finger hurts, or for a throatache instead of going to the pharmacy) OR the problem is the “greed” like:
cost of medicines
unnecessary tests ( super arguable )
unnecessary itemization ( 1 pont for calling you, 1 point for listening to you, 1 point for writing down stuff, 1 point for cleaning the chair where you sit etc) + silly costs
I wouldn’t really count it as evidence at all. It’s just my personal experience. In the case of my brother-in-law, the diagnosis happened quite early on. The rest of the time was spent waiting in line for the operation. Curiously, I have another friend in Sweden for which the operation came quite fast, but they had a life-threatening condition. So it’s possible that a kidney-stone operation simply wasn’t a high priority since it wasn’t life-threatening.