swiss health care a time for reassessment dr alphonse crespo workshps on health insurance beijing...
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Swiss Health Carea time for reassessment
Dr Alphonse CrespoWorkshps on Health InsuranceBeijing 2008
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Basic Principles
GUARANTY OF ACCESS
GOVERNEMENT SUBSIDIARITY
REGIONAL AUTONOMY
INSURANCE BASED
INDIVIDUAL RESPONSIBILITY
PRIVATE PROVIDERS
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Who pays?
11.6% of GDP IS INVESTED IN HEALTH CARE
30% out of pocket25% public subsidies35% social insurance10% private insurance
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Health Consumer Satisfaction
The European Scene
European Health Consumer Index:
Insurance based systems
Do better than
National Healthcare Services
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Reforms
After 1994
Mandatory insuranceCartel Dominated modelCost containment oriented
Subsidies target indlviduals
More federal regulatory power
Until 1994
Voluntary insurance*
Private & subsidized providers
Wide Cantonal autonomy
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Swiss Hospitals
230 public hospitals3.5 beds per 1000 inhabitants
136 private hospitals (mostly in bigger cities)0.7 beds per 1000 inhabitants AN EXPANDING SECTOR
±30% of global health expenses
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PRIVATE HOSPITAL SECTOR
Private Hospitals
Open to patients with supplementary insurance
Some exceptions for ambulatory treatment
Public hospitals
Offer private wards
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Swiss Hospitals - dual financing
Public hospitals financed through:State subsidy: 55% - Insurance : 45%(Out-patients: insurance + copayments)
As from 2009-2012:
• No public subsidies for investments & hardware • No public cover for deficits• Diagnostic related based (DRG) reimbursement• List of approved hospitals (including private)• More trans-cantonal access• More federal planning of hospitals
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Effects of cost containment
Reduction of global number of public Hospitals
• Mergers of local or regional hospitals• Centralization of specialty units• Shift of care to larger cantonal or University Hospitals• Incentives for in & out surgery
Restriction of doctor practices
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Effects of centralization?
How Safe is Big ?
Comparis Study on Swiss Public Hospital Outcomes and critical incidents - Aug. 2007
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Public dissatisfaction :
Clear Signals
March 2007: Vote on Single National Insurance Provider
72% NO June 2008:
Regulation of doctor offer
69.5% NO
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European models conceived in 19thC not adapted to challenges of the 21st C
Basic Concept for reform
RISK PROBABILITY POVERTY
need specific approaches
Sustainable health care
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Covering for RISK
Mandatory Health “Insurance”
First dollar coverage or low deductibles: Covers risks AND certaintYProvides for minor ailments
= Overuse & wasteHigh premiums
Rationing
Market based Catastrophic Insurance
High deductibles & co-payments =
Cost-consciousnessIndividual responsibilityAffordable premiums
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Providing for PREDICTABILITY
Health Savings Accounts
• Adapted to chrono-physiology of health
• Avoid inter-generational gridlocks
• Allow for more transparency & consumer pressures on prices
• Create capital
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Health Savings Accounts
From1984:
SINGAPORE Medisave : 84% of Population(+ Social insurance for high risk)
South Africa (+ Private Insurance)1994 Covers 5% of Population
USA (+ HDHP)1997- 2002 Test phase 2003 - 2006 Integrated to law
China ?Urban pilot experiments since 1994
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Caring for POVERTY
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The pillars of sustainable health care
Health Savings Accountsfor predictable health
expenditures
Risk insurance & pooling for catastrophic health
expenditures
++ Micro-insurance
Philanthropic initiatives--
Health vouchersPublic Social Services
for the needy
+ +
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+THANK YOU FOR YOUR ATTENTION
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