Swiss healthcare system Flashcards
What insurance model does the Swiss system follow?
Bismarck. Private insurance is compulsory and is used by 100% of the population.
How are hospitals characterized in the system?
Both publicly and privately owned.
Hospitals account for ~35% of total health spending.
Most of the funding comes from each Canton (55%), the rest is covered by the mandatory insurance, co-insurance and copays.
What % of healthcare spending does cost-sharing account for?
5.3%
How is insurance coverage split up?
Into 3 age groups:
- under 18
- 19-25
- 26+
* *each age group has different deductible levels
What is covered and what is not covered?
**standard coverage includes basic coverage with free choice of physician.
Covered:
hospital inpatient services
most GP and specialist services
a long list of pharmaceuticals and medical devices
home care services
PT, if prescribed
maternal health care
outpatient mental health care
medically necessary LTC
some prevention (vaccines, physicials, screenings)
hospice
Not covered:
dental
glasses and contacts, unless medically necessary
durable medical equipment (ex: wheelchair)
hearing aids
What % of the Swiss population uses alternative coverage?
65.7%
How does voluntary insurance work?
Swiss can purchase voluntary insurance to cover services that are not usually covered. Patients can be refused based on their medical history. Benefits and premiums vary. Insurers will normally have a non-profit branch for mandatory coverage and a for-profit branch for voluntary.
How is the system funded?
Mandatory coverage premiums, general taxes, and contributions to social insurance systems
How are GPs, specialists, hospitals, and services paid/financed?
Most GPs and specialists are paid through FFS, fees are negotiated annually.
55% of hospital funding comes from Cantons.
Services that are covered by the mandatory insurance are billed based on a national DRG system
How much is the average annual premium?
It ranges from $3511 USD to $5869 USD across cantons
What is the mandatory coverage deductible for adults and children (under 18?)
Adults: $248 USD
Children: $0!
**people can choose a higher deductible up to $2066 USD for adults and $496 for children and pay a lower premium
How is the choice of higher or lower deductibles distributed among the Swiss population?
54% of insured chose the minimum deductible
46% chose the higher deductible
How much coinsurance do people pay for ALL services?
10%
**this EXCLUDES maternity care and prevention
How much is charged on brand name drugs that have a generic alternative?
20% (very high drug costs)
T/F: the Cantons provide income based subsidies for the mandatory insurance
True. 27.3% of Swiss receive subsidies
