Under what conditions does managed competition equally serve insured individuals and patients?
Switzerland offers a unique healthcare system that combines competition and state regulation. At its centre is compulsory health insurance (OKP), which guarantees all Swiss residents access to the most important healthcare services. In addition, insured persons can take out voluntary supplementary insurance and pay for non-prescription services themselves.
The Swiss healthcare system is based on the principle of regulated competition. Like in countries such as Germany or the Netherlands, there is not a single state-provided insurance, but around 40 private health insurance companies that compete for insured persons in the compulsory basic insurance scheme. This comprises a catalogue of benefits defined by the Federal Office of Public Health (FOPH), which covers medically effective, appropriate and economical treatments. Health insurers are obliged to adhere to this catalogue and are not permitted to deviate from it.
To ensure that everyone has access to medical care, competition between insurers is strictly regulated: they are not allowed to reject anyone on the basis of pre-existing conditions, and premiums can only be differentiated according to geographical region and three age groups, which also require authorisation from the FOPH. Insurers in the OKP are not allowed to make a profit, and surpluses may only be used to build up reserves.
Federalism in the Swiss healthcare system
Die Finanzierung des Schweizer Gesundheitswesens verteilt sich entsprechend auf verschiedene Akteure. Die obligatorische Krankenpflegeversicherung (OKP) trägt mit 40,9% den grössten Anteil. Private Haushalte übernehmen 22% der Kosten, hauptsächlich durch Selbstzahlungen. Der Staat steuert ebenfalls 22% bei (Kantone 17,1%, Gemeinden 3,3%, Bund 2,6%). Weitere private Finanzierungsquellen decken 13% der Ausgaben.
The Swiss healthcare system is organised on a federal basis, which means that the federal government, the cantons and the municipalities share certain responsibilities. The federal government lays down the legal foundations, for example through the Health Insurance Act (KVG), and defines the catalogue of basic insurance benefits. The cantons bear significant responsibility for healthcare, particularly in the area of hospital planning and financing as well as in the training of healthcare professions. Municipalities often take on tasks in health prevention and social assistance, for example in supporting nursing homes and old people's services. This federal structure means that regional needs can be taken into account and local challenges can be responded to flexibly.
Die Finanzierung des Schweizer Gesundheitswesens verteilt sich entsprechend auf verschiedene Akteure. Die obligatorische Krankenpflegeversicherung (OKP) trägt mit 40,9% den grössten Anteil. Private Haushalte übernehmen 22% der Kosten, hauptsächlich durch Selbstzahlungen. Der Staat steuert ebenfalls 22% bei (Kantone 17,1%, Gemeinden 3,3%, Bund 2,6%). Weitere private Finanzierungsquellen decken 13% der Ausgaben.
In addition to the standard model, which includes a deductible of CHF 300 and a free choice of doctor, insurers can also offer optional deductibles of up to CHF 2500 and alternative models with a limited choice of doctor. These options offer insured persons the opportunity to benefit from lower premiums.
The prices for basic insurance benefits are set centrally and apply equally to all insurers. The FOPH sets the prices for prescription drugs directly, while other services are negotiated by so-called tariff partners - such as health insurance organisations with representatives of the medical profession - under the supervision of the FOPH. The federal government and cantons are also responsible for the authorisation of service providers in basic insurance. Insurers are obliged to reimburse the services of authorised providers.
11.8%