Hospital health insurance | Long term plan

Life Hacking
1

There are some treads but wanted to summarize pros / cons of signing hospital (either semi-private or private) health insurance for following subject:

  • Mid 30’s
  • Planning to work at least until 50
  • Retirement: 6 months CH | 6 months across south Europe and some international travel
  • Health status: some minor issues but not life threatening conditions

Pros:

  • hospital premium is not expected to go up significantly when you sign up young (SWICA claim)
  • Access to best doctors (important for elective surgeries, cancer, Etc.)
  • Private / semi-private ward. Preference for semi-private hospita and you can always upgrade
  • child birth: private clinics access for women. Birth costs 10-15k CHF, which is completely free with semi-private insurance
  • Treatment abroad: + CHF 100/day and CHF 10k per year for treatment cost
  • Emergency transfer / rescue ops: 90% & no upper limit / 90% & 20k upper limit
  • others

Cons:

  • Costs: 2780 CHF per year / couple = 140k CHF over 50 years without price adjustments. More likely real cost would be double over 50 years
  • high quality hospitals in Switzerland and low waiting times. Switzerland has relatively healthier mix between young and old (population over 65s is less than other EU countries) and sustained influx of young foreigners

Overall, semi private is a significant lifetime investment but also a great piece of mind. When I consider retiring in Southern Europe, health is always of a concern. Health systems are stretched as hell. With the amount of money you save vs Switzerland you could argue you could find / pay good private doctors but again you need to know whom to contact and the older you get the less hassle you want to go through and just get timely and high quality visits.

Happy to hear from others their views and other significant pros / cons of going with hospital private or semi private

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Will try to debunk. According to my knowledge (we explored this question and it could be region-specific), what you get is just a hotel-like accomodation. In case you have serious problems, they transfer you to the public hospital, where real specialists treating complicated cases are located.

We paid extra (ca. 500 CHF per day) for an individual room in the public hospital. They told us that it is possible if these rooms are not occupied by patients with private insurances. Worked both times and it doesn’t look these rooms were heavily occupied. But even if we wouldn’t get a separate room, it would be just a double occupancy room.

Also my wife, who is not extremely frugal, said that private medical insurance was not worth for birth.

Aren’t they should be covered by travel insurances?

I don’t think you can use insurances for Swiss residents in this case.

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Also some limited knowledge/experience on my side. At least in touristic places, “southern” countries tend to have dedicated private hospitals for foreigners. You get quick and good treatment which costs much (?) more than normal local prices.

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My simplified mental model of private/semi-private insurance is, that if I had to go to the hospital, I would get in addition to the necessary medical treatment (which everybody gets in Switzerland) a luxury stay in a 5-star hotel like room with a gourmet menu a la carte, which I don’t really see a need to insure for.

What I actually want when in a hospital is to be treated by a medical professional. If they would house me in a lazaret in a tent on a parking lot of the hospital while doing that and feed me with glucose IV, I wouldn’t really mind.

P.S.: I’ve stayed in hospitals in eastern european countries, I seriously doubt that basic insurance in CH can get me a worse experience.

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Thank you All!

Any other views on why signing up may make sense? Or other experiences from people on both sides?

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Except for the free choice of the doctor and the hospital, it doesn’t make much sense. A surgery (unless vital of course) could be organised more quickly.

It’s a premium you pay for an “extra service” that you may never use.

It’s easier to get insured when you’re young and healthy. It could become trickier when you get old or already have some health problems. The insurance can refuse you.

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8

I have full private with main logic I want to be able to access the best doctors if I get cancer. Survival rates are higher in the US, they get 90% of the new treatments and trials before they trickle down to the rest of the world (I assume to the specialist clinics first)

I haven’t fully analysed if this approach makes sense and if there is an alternative way (just pay cash for treatment?). However 40% of us will get cancer in our lives, there is a history in my family and risk increases with age.

So going with basic as I get older and whilst I plan to RE would seem shortsighted. My only question was full vs semi private. Premiums are also partly tax deductible

I am in my mid 40s and male. If i was younger I might go with basic. Probably before ~50 is a good limit if you want to switch, I got a good offer via my employer which pushed me to change sooner

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Where do you get that number from?

https://www.cancer.gov/about-cancer/causes-prevention/risk/age#:~:text=Age%20and%20Cancer%20Risk&text=The%20incidence%20rates%20for%20cancer,groups%2060%20years%20and%20older.

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I searched “how many people get cancer in their lifetime”

UK NHS says the lifetime risk is 50%

I have read before this % is going up as we are living longer

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There was an article (will try to find it later) saying that everybody would get cancer if we would live forever. From a biochemical standpoint that makes sense as cancer is at the end just a cell that is going crazy which happens daily in our bodies however, our own repair function usually finds these crazy cells and repairs or separates them out.
And still there are factors which seems that they enhance the chance to get cancer earlier. In any case working in a cancer research company I’m still very much impressed by our own immune system and that even after decades of research with some of the most brilliant minds in it we still do not really understand our body.

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I can share a recent experience my partner went through (literally writing this from the clinic parking lot right now).

With half-private you get the majority of the benefits already, honestly being an expat and having experienced a lot of healthcare and hospitals abroad (both eastern and non-eastern European countries) I have to say that the level of care seems in line with the western EU, nothing substantially different. What you get extra are luxury creature comforts like the menu, a better looking room, maybe decent nurse-to-patient ratio, someone takes care of your flowers, max. one other person in the room (or none for private), etc. etc.
The medical equipment is exactly the same, the medical procedures are the same, the outcome is, AFAIK, the same.

Till you are young and visits to hospitals are rare, there doesn’t seem to be any added benefit worth the price. Even with an emergency that would put you in bed for a month, it is a good healthcare regardless of the level of insurance and you can certainly endure not being alone in a hospital room for a few weeks. Also probably one has more important worries then.

The only real consideration should be access to specific doctors and/or clinics which are accepting only higher tiers insured patients, and this is a risk I’m not able to price adequately. Gut feeling says it’s probably cheaper to pay out of pocket in such cases, treatments are generally fine with any doctor and only certain areas may require a well-known specialist. YMMV

I’d be curious whether there is a significant gap in survivability rates between doctors, I’m very doubtful there is meaningful difference in Switzerland.

My takeaway here is also to invest rather the difference in preventive care such as screenings, sport, regular visits, etc. so as to catch any onset early. I truly do not understand why paying for a higher tiers insurance gives you the useless access to a-la-carte menu but your important screenings are still covered only every three years and quite basic at that.

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13

I’d like to add something that I personally keep forgetting: we are talking about an health insurance, not an accident insurance. I keep forgetting that I fall from my bike it’s not my health insurance that pays but my accident insurance, which in my case is totally different, being paid by the company I work for.
If I were FIRE’d it would be different of course.
(Interesting is that I have no idea what/how they cover stuff)

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Ask your employer, mine is pretty generous, private healthcare worldwide.

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I’ve heard that it’s harder to get semi-private the older you get. Any ideas what are criteria: eg health history or so?

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And it is also cost more from what I heard. Of course it’s a nice selling point from the insurance that makes money out of you for a longer period of time.

Then technically there is pre-existing condition. Usually insurances don’t like to cover a pre existing condition

17

Thanks for your input here. This is a quite important point. How important is to be able to choose a specific clinic or best doctors? I have some arguments for pros and cons.
Pros:

  • a more experienced doctor may diagnose faster the real issue (provided it’s not straightforward)
  • the best doctors may be using more recent drug innovation and offer higher overall survival rates for cancer patients
  • you may have the option (to be validated) to get multiple opinions which I heard it’s important

Cons

  • it may not be easy to know upfront who are the best doctors except from word of mouth recommendations
  • best doctors are also very busy - so not sure if you want a young but more focused doctor

If it would be good to hear from some doctor on the forum or other people having gone through a serious condition whether private/semi private and option to choose doctor led to a better outcome or not. I think we have some docs on the forum. @s0974748?

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The younger doctors might use the newest tecniques since they are fresh out of school.
The older doctors might be a bit less mobile or maybe so used to stuff that they go on autopilot and forget stuff.

See? You can always find a counterexample.

(I’m a professional devil’s advocate :slight_smile: )

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As another example, now I’m with the RAV and they offer (well, the ALK) better accident insurance than my previous employer… I’m surprised, but it’s always good to check before you need it :slight_smile:

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Your points are valid, but you have to price them to compare against the additional cost.

I would say the only important part here is when you actually have to have a serious surgery or treatment, in that case you may want to go with a well-known surgeon or specialist in the field. (Not that his lesser known colleagues are necessarily worse ofc)

For things like diagnosis and second opinions, out of pocket will definitely be cheaper.
I feel that in Switzerland there is the tendency to over-prescribe exams (anedoctal experience, but makes sense in a pay-for-health economy), so even if you have basic insurance, if the doctor asks for multiple exams and whatnot just to be on the safe side, you are covered.

21

I did took freedom of choice only because with children it may be easier to organize their schedule if I get treatment on my home Canton (Ticino) and the kids can stay with grandparents. Now we live in Romandie.
So proximity to family may be a point for freedom of choice. To me it was more important than doctor reputation tbh.

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