Switzerland’s Universal Health Care Model

According to the World Health Organization, 

“Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care (World Health Organization [WHO], 2021).”

Switzerland’s health care system is more cost-efficient than the health care system in the United States (Cahn, 2019). Switzerland’s universal health care system holds much influence at the state-level. Premiums, taxes, social insurance donations, and out-of-pocket payments fund the universal health care model. Swiss residents must have private non-profit insurers’ insurance. The health care plan includes most doctor appointments, hospital and home care, pharmaceutical needs, medical technology and devices, physiatrics, general practice and specialized services, prevention check-ups such as but not limited to screenings and examinations, maternity care, outpatient care for mental illness as diagnosed by a physician, hospice care, and long-term care (Djordjevic, Mossialos, Osborn, Tikkanen, & Wharton, 2020). According to the National Institutes of Health, no resident is denied coverage for pre-existing conditions in Switzerland. Patients do not need referrals for various levels of care, not to mention the minimal waiting times to see a provider. Maternity care includes pre-natal care, full coverage of delivery term, and a post-delivery hospitalization for one week, one in which mothers are taught about taking care of their babies (Cahn, 2019). Medical equipment is not covered, hearing aids are only covered if there is proof of no elderly or disability insurance, and dental care is unheard of for adults through the universal health care plan, as are glasses and contacts for adults. Interestingly enough, these services are rendered as available under the universal health coverage for children until age 18. The minimum annual deductible fee for the obligatory insurance coverage is CHF 300, equivalent to $248 U.S. dollars. In addition to this mandate, the insured have a 10 percent coinsurance fee for all medical services excluding a few preventive and maternity care assistances. Supplemental private insurance, if chosen by the patient in addition to the mandatory insurance, would cover additional physician and hospital options (Djordjevic, Mossialos, Osborn, Tikkanen, & Wharton, 2020).

From the inception of the Swiss Health Insurance Law 1994, universal health care in Switzerland has included subsidies for those with lower incomes, competitive standards for health services, and containment of the increasing costs of health care. This law, which was effective in 1996, ensures that nearly 100% have health insurance coverage. Unlike in the United States, a separate insurance must be applied per dependent. The optional private health insurance is regulated by the Swiss Financial Market Supervisory Authority. New residents obtain an insurance policy based on their arrival date, while undocumented immigrants’ health care continues to be unobtained, as there is no mandatory protocol for this population. Temporary nonresidents are responsible for their own health care needs. The expenses are covered by their home country’s insurance program (Djordjevic, Mossialos, Osborn, Tikkanen, & Wharton, 2020). There are no employer-run insurance programs in Switzerland (Roy, 2011). Switzerland has kept the private insurance market while still being able to have universal health care coverage. The government sets the amount to pay for medicines and procedures (Brangham & Kane, 2020).

The federal, cantonal (state), and local governments work mutually to enact the Swiss health care model. The are 26 cantons that are autonomous in responsibility for various health services decisions. The federal government mainly focuses on macro-level public health systems training and funding in addition to monitoring the quality and usability of pharmaceuticals and medical devices. The federal and state level work in conjunction to give income-based allowances to individuals or households covering the mandatory health insurance premiums, income maximums being designated per canton. The municipal level focuses mainly on elderly and vulnerable populations. Denote that the main governance for the universal health system in Switzerland is at the cantonal level. Each state has a governing Minister of Public Health, a political body, and there is also the Swiss Conference of Cantonal Health Ministers. Other health agencies in Switzerland include the Federal Office of Public Health, The Swiss Federal Department of Home Affairs, and nonprofits such as Swiss DRG AG, Health Promotion Switzerland, and The Association of Swiss Patients (Djordjevic, Mossialos, Osborn, Tikkanen, & Wharton, 2020).

Care coordination is a weakness of Switzerland’s health care system. There is a future decrease of health care practitioners and need for increased efficiency and capacities. Statutes to oversee the improvement of care coordination include the following: addressing palliative care, dementia, noncommunicable diseases, and mental health through projects targeting the co-interaction of various health professionals. The Federal Office of Public Health aims to better coordinated care through economic, education, and electronic health record programs (Djordjevic, Mossialos, Osborn, Tikkanen, & Wharton, 2020). Another flaw of the Swiss model is that the mandatory health insurance premiums are getting higher faster than Swiss incomes. Low and middle income classes give more than from their profit to financing health care than the high class (Cahn, 2019). Nonetheless, Switzerland was the top-ranked country in the 2020 World Index of Healthcare Innovation by the Foundation for Research on Equal Opportunity (Roy, 2011).

The main areas of reform as outlined in the Swiss federal government’s Health 2020 are information technology, ambulatory care, and health care for the special needs population. Most of the future reforms to health law are edits to the KVG/LAM. An example of major reforms from the past decade include improvement of risk adjustment, which required expenses of pharmaceuticals exceeding Sw.fr.5000 to be reimbursed by the obligatory health insurance (Camenzind, Crivelli, De Pietro, Edwards-Garavoglia, Quentin Spranger, & Wittenbecher, 2015).

United States’ Multiple Payer Health Care Model

The United States has one of the best clinical care models globally however health equity is a major issue. Most American citizens have health insurance obtained through their employer. The employee’s dependents may also be covered by the employer’s insurance. Medicare is a federal program which provides health care for seniors and some disabled individuals in the U.S. The government program focused on health care for the impoverished population is called Medicaid. The Children’s Health Insurance Program (CHIP) targets children of low-income neighborhoods. The constant debate of health care reform aims to target uninsured populations in the U.S.; health care reform often cites the Affordable Care Act (ACA). Managed care health systems aim to enact efficiency in the health system, lead use of medical services, and determine provider pricing for services. The primary donor of managed care is either the government or employer. In managed care, the employer contracts with a managed care organization to offer a health plan to its workers (Shi & Singh, 2019). 

The United States has a privately-financed, multiple payer system health care model heavily focused on specialized services. Through the multiple payer system, providers often do not account for various health plans and services, therefore hiring billing services. Administrative costs happen to be a national problem. Most hospitals and clinics are small businesses unaffiliated with government practice and equipped with the latest technologies. Although there is no main federal agency centralized in health care, federal and state governments contribute to health system and structure through health policies, deciding public sector expenses and reimbursement rates for Medicare, Medicaid, and CHIP clients (Shi & Singh, 2019). 

The Democratic Party 2020 Campaign nominees had various interpretations of how to achieve a universal health care model to emulate for the United States, although universal health coverage had not been enacted. Senators Bernie Sanders and Elizabeth Warren respectively advocated for a single-payer health care system which would allow all citizens to obtain health insurance through the government. Sanders further emphasized the need to end private insurance, premiums, copays, and deductibles. More moderate Democrats pushed for a revision of the Obama era Affordable Care Act. Current President Joe Biden ran under the platform of expanding the Affordable Care Act to create publicly available options like that of Medicare (Hagan, 2019).

Lessons and Response to the Coronavirus Pandemic for Switzerland

The first wave of the COVID-19 pandemic in Switzerland was carried out by protecting the citizens through military intervention. The Swiss army mobilized several thousand Swiss residents. The ‘lockdown’, as popularly named by Switzerland’s media, lasted from March 16th until April 26th 2020. From January to April 2020, unemployment increased from 121,018 to 153,413. The second wave of coronavirus prompted the Federal Council and the Federal Office of Public Health to reinstate protection initiatives in October 2020. Before the start of December 2020, 153,270 individuals were reported to be unemployed (Gashi & Riguzzi, 2021). 

Switzerland’s health care staff faced high risk infection rates for COVID-19 in addition to being a risk for their social environments. Being perceived as heroic by mass media can further impact health care workers’ mental health and even produce trauma. In mid-October 2020, during the second wave of coronavirus, the following entities advocated to the government for health care staff: the Swiss Society of Emergency and Rescue Medicine, Switzerland Emergency Care, and the Swiss Association of Paramedics (Gashi & Riguzzi, 2021). 

Gashi and Riguzzi’s study results showed that the sample of Swiss health care professionals studied had much clinical knowledge about COVID-19, however were not aware of all topics regarding COVID-19. More than one third of the participants falsely believed that washing of the hands and sneezing into tissues would be enough to remove the transmission of COVID-19. Most of the participants also believed they did not need further guidance or education on COVID-19. The study exemplifies how by the first wave of the pandemic health care professionals were not ready to synthesize essential topics regarding how to provide and protect others during the COVID-19 crisis. Improvements could be made in the following areas: increased medical equipment, addressing physical and mental health concerns of health workers, increased pay rates for health care workers to address the need of longer hours worked, detailing the symptoms of COVID-19 by the employer or other means, and the diverse situation of the health care workers versus their individual situations (Gashi & Riguzzi, 2021). Another area of concern has been potential terrorism threats. Switzerland’s Federal Intelligence Service warned of potential entrances of terrorist groups on August 29, 2021. The terrorists were predicted to target coronavirus vaccine locations, delivery and manufacturing spaces (The Straits Times, 2021).

Lessons and Response to the Coronavirus Pandemic for the United States

The United States government response to the coronavirus pandemic as it relates to health & safety measures ensures the involvement of the following agencies, nonexhaustive: Administration for Children and Families, Administration for Community Living, the Army Public Health Center, Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid, Consumer Product Safety Commission, Corporation for National and Community Service, Defense Commissary Agency, Department of Defense, Department of Energy, Department of Health & Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response, Department of Homeland Security, Department of Labor, Department of the Interior, Department of Veterans’ Affairs, Drug Enforcement Administration (DEA), Environmental Protection Agency, Federal Bureau of Investigation (FBI), Federal Emergency Management Agency, and the Food and Drug Administration. Various roles these agencies have include but are not limited to news reporting, research and program information, having guides for Medicare and Medicaid recipients, military health, fighting coronavirus in the workplace, disinfectant and water control (USA.GOV, 2021).

President Joe Biden is being criticized for delivering unkept promises regarding the distribution of vaccinations internationally, particularly to underdeveloped countries. Scientists state 11 billion vaccines would be needed to slow the spread of coronavirus worldwide, whereas Biden only advocated for 600 million vaccine doses abroad. Senator Elizabeth Warren and House Representative Raja Krishnamoorthi lead moving legislation to increase funding for vaccines abroad. The United States had given 115 million doses that were extra of the country’s supply, in addition to buying 500 million vaccines from Pfizer and BioNTech (Stolberg, 2021). Since March 1, 2021, at least 15.1 million doses of coronavirus vaccines have been wasted, which only includes reported numbers. Walgreens pharmacy reported 2.6 million unused doses, CVS pharmacy had 2.3 million unused doses, Walmart pharmacy 1.6 million, and Rite Aid 1.1 million. CDC data has unreported numbers for the federal agencies providing vaccines (Eaton & Murphy, 2021).

Recommendations

The Commonwealth Fund states that although the United States invests the highest proportion of its gross domestic product on health care, the United States has the weakest health system overall in comparison to 11 high-income nations. The variables of this study included care accessibility, health care retrieval process, administration, and health equity. More investments in primary care are recommended (Parker, 2021). It would also be recommended to find alternate solutions to unutilized coronavirus vaccines so they do not go to waste in the United States (Eaton & Murphy, 2021). The United States would benefit from the emulating the Switzerland health model.

Ingrid Noriega pursued a bachelor's degree in International Affairs from the School of International Service while at American University. Ingrid is mainly interested in environmental justice, fine arts, life, health, & behavioral sciences topics.

References

An Overview of U.S. Health Care Delivery. In Shi, L., & Singh, D. A. (2019). Delivering Health Care in America: A Systems Approach, (7th edition, pp. 1-38).

Brangham, W. & Kane, J. (2 September 2020). How Switzerland delivered healthcare for all- and kept its private insurance [Video]. PBS News Hour. https://www.pbs.org/newshour/show/how-switzerland-delivered-health-care-for-all-and-kept-its-private-insurance

Cahn, L. (21 March 2019). Why Switzerland has the best healthcare system in the world. Yahoo Finance. https://finance.yahoo.com/news/why-switzerland-best-healthcare-system-210658462.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAAK1KG0O_MG_PRt_imVgdrPnmZTt4vPsLbpXjt1U3GumpOooXgbkZCl8y_eqpFiOW0wIb45Fjjf-rIdyQ7U5wnwwgjrSfP3UdhPr0mmSAPNd6CyurgRTa1N27ioWtlMh5f0OLOs-ajKxoh7AgS86vwiZ_PkftG4S0fKR2VgQGA7C

Camenzind, P., Crivelli, L., De Pietro, C., Edwards-Garavoglia, S., Quentin, W., Spranger, A., Wittenbecher, F. (2015). 2015 Switzerland: Health System Review. Health Systems in Transition, 17(4), 1-287.

https://www.euro.who.int/__data/assets/pdf_file/0010/293689/Switzerland-HiT.pdf

Djordjevic, A., Mossialos, E., Osborn, R., Tikkanen, R, & Wharton, G. A. (5 June 2020). International health care system profiles: Switzerland. The Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/countries/switzerland

Eaton, J. & Murphy, J. (1 September 2021). America has wasted at least 15 million covid vaccine doses since March, new data shows. CNBC. https://www.cnbc.com/2021/09/01/america-has-wasted-at-least-15-million-covid-vaccine-doses-since-march-new-data-shows.html

Hagan, L. (11 October 2019). Where the 2020 Candidates Stand on Health Care and Medicare for all. U.S. News. https://www.usnews.com/elections/health-care-2020

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Stolberg, S. (25 August 2021). Biden falls short on pledge for U.S. to be the world’s vaccine ‘arsenal’, experts say. The New York Times. https://www.nytimes.com/2021/08/25/us/politics/biden-coronavirus-vaccine.html

The Straits Times (29 August 2021). Switzerland warns of terror attacks in COVID-19 vaccine sites. 

https://www.straitstimes.com/world/europe/switzerland-warns-of-terror-attacks-on-covid-19-vaccine-sites

USA.GOV. (23 June, 2021). Government Response to Coronavirus, COVID-19. https://www.usa.gov/federal-covid-response

World Health Organization. (2021). Universal health coverage. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1