The Scandinavian and Swiss Systems, Expensive Healthy Care Systems. Are they worth it?

12376055_809796325816695_1717551687001728436_n

The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway, as I discussed last week, and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatize any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.

 

Swiss healthcare is outstanding. Its combined public, subsidized private and totally private healthcare system create an extensive network of highly qualified doctors (many of them from elsewhere in the EU) and hospitals, the best equipped medical facilities and no waiting lists, but it all comes at a price: around 10 percent of the average Swiss salary goes towards health insurance premiums. ­ There is no free state health service in Switzerland.

 

Unlike other European countries, the Swiss healthcare system is not tax based or financed by employers but is paid for by the individual through contributions into health insurance schemes. The system is universal but it is administered by individual cantons. This means that everyone living in Switzerland must have basic health and accident insurance (Soziale Krankenversicherung / Assurance maladie / Assicurazione-Mallatie). You pay monthly premiums to the insurer and you also have to pay a contribution towards the cost of medical consultations and treatments. Each family member must be insured individually. Babies are insured from birth but to continue cover, you have to take out health insurance for a child within three months of the birth. Children don’t need to be insured by the same company as their parents. As at 2014, an adult pays around CHF 400 (1CHF):1.01 (US dollar) in health insurance premiums.

 

If you are in Switzerland for less than three months, you may be exempted from the requirement for holding basic health insurance if you have an European Health Insurance Card (EHIC), your own health insurance policy, travel insurance or a company healthcare plan – but check with your cantonal authorities to make sure.

 

After three months everyone has to have organized cover with an authorized Swiss insurer even if you have an international health insurance policy, as these are not usually recognized in Switzerland.

 

Many people top up the basic cover with supplementary private health insurance. Switzerland has one of the largest private healthcare sectors in the world.

 

Basic health insurance in Switzerland is based around 80 health insurance companies in Switzerland, each offering the same benefits in their basic health insurance policies and they are obliged to accept anyone who applies, regardless of pre-existing health conditions.

The basic health insurance policy covers:

  • Out-patient treatment by officially recognized doctors;
  • Emergency treatment;
  • A contribution to transport/rescue expenses;
  • Medicines prescribed by a doctor and on an official list;
  • Maternity check-ups, tests, ante-natal classes, childbirth;
  • Abortions and gynecological check-ups;
  • Vaccinations;
  • Rehabilitation after operations or illness;
  • Medical treatment when on short trips outside of Switzerland;
  • Some alternative therapies, like homeopathy and Chinese medicine and psychotherapy if this is given within the medical practice.

What does the patient contribute for their health care coverage?

In any given year, adults have to pay the first CHF 300 of any medical treatment themselves, except for maternity services. This contribution is called an ‘excess’. The insurance will only pay what exceeds the excess and even then, the patient has to pay 10 percent of that amount. This is called the ‘deductible’ and is limited to CHF 700 per year or CHF 350 per year for children. If you need to go to hospital, you have to pay CHF 15 per day.

You are free to choose your own insurer. But monthly health insurance premiums may vary from company to company and most charge less for those aged under 25.

You can pay cheaper premiums if you:

  • Choose a policy with a restricted choice of doctor or HMO (health maintenance organization);
  • Take out a Telmed policy which requires you to call a telephone counseling service staffed by medical professionals who can refer you to a doctor or hospital;
  • Increase your excess from CHF 300 up to CHF 2,500 per year which means that you pay more if you’re ill but have lower premiums when you’re well;
  • Have a ‘modest’ income – this is determined by individual cantons and you need to contact your local cantonal authorities for more information.

 

You can take out optional supplementary health insurance at an extra cost from the same or separate insurer. Benefits vary from policy to policy but may include orthodontic treatment, spectacles/contact lenses, choice of doctor when you need treatment in hospitals, and stays in a private or semi-private hospital ward. The more benefits you get, the higher the premium. Companies can refuse to insure you or refuse or terminate the policy if you give incomplete or inaccurate information.

Look on the Federal Office for Public Health website for a list of insurers and an annually published list of premiums to compare prices.

 

If you already have an EHIC you can get public medical treatment in Switzerland at a reduced cost while you are in the country for the first three months. EHIC does not cover private treatment. Keep any paperwork and receipts to apply for refunds or reimbursement on your return to your home country.

 

Once you take up permanent residence and/or employment you are no longer covered by the EHIC and must register with a Swiss health insurance company

You are usually free to choose your own family doctor (Doktor/ Arzt / Médicin / Medico) unless your insurance policy places a restriction on choice of doctor, for example, if you have a cheaper policy plan (see above). In Switzerland, people also choose a pediatrician to look after the health of their children. The doctor can treat you and refer you onto specialists in a polyclinic (out-patient clinic) or hospital. Unless your insurance policy specifies otherwise you may also consult specialists without a referral from your doctor and be covered by your insurance.

 

You can find a doctor by personal recommendation, at www.doktor.ch or www.doctorfmh.ch, or by looking in the health section of the Swiss Yellow Pages where you’ll find doctors, dentists, pharmacists and other health professionals. Your embassy or consulate may be able to recommend a doctor who speaks your native language.

 

You’ll need to book your appointment beforehand and give 24 hours notice if you need to cancel otherwise you’ll be charged. Take your insurance card when you visit the doctor.

 

Hospitals in Switzerland

Hospitals are called Krankenhaus / Spital / Hospital / Ospedale – look for a sign with a white ‘H’ on a blue background. Unless it’s an emergency, you have to be referred to a hospital by a doctor. The hospital will usually be in your local canton. You’ll need to take your EHIC or proof of your Swiss health insurance policy. There are three types of wards: general (two to four patients), semi-private (two patients) or private for one patient only. If you have private health insurance you can also choose your own doctor. Basic health insurance covers medical and nursing care and outpatient follow-up although you will be asked to pay CHF 15 per day towards these costs.

Are there additional medical bills and how are they handled?

After your consultation or treatment, you’ll receive a bill from the doctor or hospital. You need to pay within a specified period of time and then send a copy to your insurance company who will reimburse you the amount covered by your scheme. If you have to go to hospital but don’t have adequate health insurance for your treatment you may be asked to pay a deposit of up to CHF 10,000.

Pharmacies in Switzerland

Pharmacies (Apotheke/Pharmacie/Farmacia), clearly marked with a green cross, are good places to get health advice as well as medicines. The first time you get prescription medicines from a pharmacy you’ll be asked for a small, one-off fee to open a patient file in which the pharmacy will record all your medications. If you go to another pharmacy you’ll have to do the same there so it makes sense to try to go to the same pharmacy each time.

 

Pharmacies are open usual business hours, 8am to 12pm then 2pm to 6pm Mondays to Fridays; Saturdays they close earlier around 5pm.

If you need an emergency out-of-hours pharmacy you can find the nearest one to you on this SOS-Pharmacy website (in English). Medicines cost more at out-of-hours pharmacies.

If you’ve been prescribed a branded medicine you’ll be asked to pay a deductible of 20 percent but only 10 percent on generic medicines, so ask the pharmacist if there’s a generic equivalent for cheaper prices. Non-prescription medication is not covered by insurance.

Visiting the dentist in Switzerland

The dentist is called Zahnärzte / Dentiste / Dentista and may work in either a private dental practice or public dental clinic. Most dental care is not covered by the basic health insurance and can be extremely expensive in Switzerland. Unless you’re covered by private insurance, it might be worth getting extensive dental treatment on a trip back home.

 

Adults must pay for their own dental check-ups and treatment although treatment for problems caused by serious, unavoidable, illness is covered by the basic health insurance. Children’s teeth are checked free of charge annually by school dentists but parents must pay to treat dental decay, although some local authorities may subsidize the cost. Most people take out complementary insurance to cover dental costs.

Pregnancy and birth in Switzerland

Make your first appointment with your family doctor or gynecologist. You may also book an appointment with a midwife. You’ll see the doctor or midwife throughout your pregnancy for tests and check-ups. You can give birth in a hospital, birthing center or at home.

 

The basic health insurance covers you for seven check-ups, two ultrasounds, allows CHF 100 for ante-natal classes, the cost of childbirth and post-natal care, three breastfeeding sessions and a follow-up exam. You pay nothing towards these costs.

 

In Switzerland it’s legal to have an abortion up to 12 weeks after conception without a doctor’s consent; from the 13th week, a doctor must confirm that it is necessary for the woman’s physical or psychological health to terminate the pregnancy. The cost of a termination is covered by the basic health insurance.  

In an emergency

Emergency treatment is covered by the basic health insurance and you can consult with any doctor or hospital directly in an emergency, even if you have a restricted choice, HMO or Telmed policy. You may be asked for your health insurance details even in an emergency so keep them with you at all times.

 

There are emergency doctors’ services throughout the night and at weekends; call your family doctor for the number.

 

The Swiss have achieved near universal coverage. But even before the reform, 96 percent of the population was covered. They’re a very risk-averse society. The culture is that you just don’t go uninsured. Now, with reform, they’re close to 99 percent. But the country is still struggling with how to handle individuals who fail to comply with the mandate — mainly the poor and recent immigrants.

 

The Swiss report that the quality of care is excellent. Waiting times are not reported to be a serious problem in Switzerland, and most people can get the services they need quite expeditiously. Modern, high-technology services are readily available. Coverage of some new drugs and procedures, however, is reviewed for effectiveness, and some drugs and procedures available in other countries may not be available in Switzerland if they are not considered to be cost-effective.

 

Switzerland hasn’t done well at controlling costs. Switzerland is second only to the United States in the percent of G.D.P. spent on health care. It’s also second to the United States in the rate of health care inflation. Probably the most important reason is that Switzerland is a wealthy nation, and wealthy nations spend more on medical care. But a particular problem is that the Swiss use more health care resources than even we do in the United States, with more doctors, hospitalizations and certain high-tech procedures.

 

The study of medicine takes six years; on completion of their studies in medicine, the students are awarded the Federal Medical Diploma. They are then able to work as employees in hospitals or private practices. Questions about the study of medicine can be directed to the deanship of the medical faculties and the Rectors’ Conference of the Swiss Universities.

Due to the national commitment to education and the generous funding from federal and cantonal governments, tuition fees at Swiss universities are relatively low.

Some reports though suggest that medical education costs in Geneva is up there at the top with high prices.

 

It is also very difficult to get a place at the university medical schools. Switzerland does not train enough doctors, and for the next 5 years the situation will not get better. I think I read that starting in 2016 there will be an extra 600 study places.

 

After receiving the Federal Medical Diploma or a medical diploma approved by the Commission for Medical Occupations (Medizinalberufekommission, MEBEKO), graduates enter the specialist training phase. Specialist training takes three years for the most basic title of “general practitioner”. The training occurs at approved educational facilities and is completed by taking the medical specialist exam.

 

With 8 million people in a beautiful, clean, well-run, sensible, technologically advanced, benevolent, rich, well-educated and more superlative ways, it sounds like what we ought to be like here in the U.S. Swiss citizens vote on issues by plebiscite and it seems like they are well informed. They vote on what should go on in their country and not a senate or a house of representatives that are bought out by lobbyists. What a mess.

Take any national or local issues, and the Swiss are on to them. If there is a major reason why a health care system like theirs won’t work in the U.S., it is because American ideals have not been lived but just “dreamed” about. That’s also why our government is in a dream world. The American Government is failing too much and succeeding to little. Our personal and national debt and horrendous economic condition is going to make a kind of Swiss Health Insurance system not work here is this country. The United States has too many people who don’t pay taxes and who eat such unhealthy food so as to make them obese and sick. Before we go too much in to health care plans, we should not be so sick from unhealthy lifestyles, and our government could actually help to discourage the food industry from fostering unhealthy edible substances so that we will eat healthy and greatly reduce the cost of health care. That does seem to suggest Socialism. But wait; our health care system is already socialistic to a significant degree. Millions of people get free health care for nothing! They don’t even pay taxes. No wonder the Swiss system won’t work here. No system will work here unless there are major changes made on many levels.

 

So, on to look at the other expensive systems, the Scandinavian health care systems.

See you all next week.

 

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s