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Health Expenditure per capita (in PPP-adjustedUS$) among several OECD member nations. Data source: OECD's iLibraryLife Expectancy of the total population at birth from 2000 until 2011 in Switzerland compared to several other nations. Data source: OECD's iLibraryHealthcare spending vs life expectancy for some countries in 2007Statue of Anna Seiler[de], founder of Bern's Inselspital in 1354.
Switzerland has universal health care,[3] regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).[4][5][6]
Health insurance covers the costs of medical treatment and hospitalisation of the insured. However, the insured person pays part of the cost of treatment. This is done (a) by means of an annual deductible (called the franchise), which ranges from CHF 300 (PPP-adjustedUS$ 489) to a maximum of CHF 2,500 (PPP-adjusted $4,076) for an adult as chosen by the insured person (premiums are adjusted accordingly) and (b) by a charge of 10% of the costs over and above the excess up to a stop-loss amount of CHF 700 (PPP-adjusted $1,141).
Compulsory coverage and costs
Since 1994, all Swiss residents are required by federal law to purchase basic health insurance[7], which covers a range of treatments detailed in the Swiss Federal Law on Health Insurance (German: Krankenversicherungsgesetz (KVG); French: la loi fédérale sur l’assurance-maladie (LAMal); Italian: legge federale sull’assicurazione malattie (LAMal)). It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic mandatory insurance but can on supplemental plans.[3]
The insured person pays the insurance premium for the basic plan. If a premium is too high compared to the person's income, the government gives the insured person a cash subsidy to help pay for the premium.[8]
The universal compulsory coverage provides for treatment in case of illness or accident (unless another accident insurance provides the cover) and pregnancy.
Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person pays part of the cost of treatment. This is done by these ways:
by means of an annual excess (or deductible, called the franchise), which ranges from CHF 300 (PPP-adjustedUS$ 489) to a maximum of CHF 2,500 (PPP-adjusted $4,076) for an adult as chosen by the insured person (premiums are adjusted accordingly);
by a charge of 10% of the costs over and above the excess. This is known as the retention and is up to a maximum of 700CHF (PPP-adjusted $1,141) per year.
In case of pregnancy, there is no charge. For hospitalisation, one pays a contribution to room and service costs.
Insurance premiums vary from insurance company to company (health insurance funds; German: Krankenkassen; French: caisses-maladie; Italian: casse malati), the excess level chosen (franchise), the place of residence of the insured person and the degree of supplementary benefit coverage chosen (complementary medicine, routine dental care, half-private or private ward hospitalisation, etc.).
In 2014, the average monthly compulsory basic health insurance premiums (with accident insurance) in Switzerland are the following:[9]
CHF 363.55 (PPP-adjusted $593) for a young adult (age 19–25)
CHF 91.52 (PPP-adjusted $149) for a child (age 0–18)
International civil servants, members of embassies, and their family members are exempted from compulsory health insurance. Requests for exemptions are handled by the respective cantonal authority and have to be addressed to them directly.[10]
Private coverage
The compulsory insurance can be supplemented by private "complementary" insurance policies that allow for coverage of some of the treatment categories not covered by the basic insurance or to improve the standard of room and service in case of hospitalisation. This can include complementary medicine, routine dental treatments, half-private or private ward hospitalisation, and others, which are not covered by the compulsory insurance.
Premiums
As far as the compulsory health insurance is concerned, the insurance companies cannot set any conditions relating to age, sex or state of health for coverage. Although the level of premium can vary from one company to another, they must be identical within the same company for all insured persons of the same age group and region, regardless of sex or state of health. This does not apply to complementary insurance, where premiums are risk-based.
subsidised private: the home care services to which one may have recourse in case of a difficult pregnancy, after childbirth, illness, accident, handicap or old age;
totally private: doctors in private practice and in private clinics.
The insured person has full freedom of choice among the recognised healthcare providers competent to treat their condition (in their region) on the understanding that the costs are covered by the insurance up to the level of the official tariff. There is freedom of choice when selecting an insurance company (provided it is an officially registered caisse-maladie or a private insurance company authorised by the federal law) to which one pays a premium, usually on a monthly basis.
The list of officially approved insurance companies can be obtained from the cantonal authority.
Electronic health records
Before the discussions about a nationwide implementation, electronic health records were widely used in both private and public healthcare organizations.[11]
In 2007, the Swiss Federal Government approved a national strategy for adoption of e-health.[12] A central element of this strategy is a nationwide electronic health record. Following the federal tradition of Switzerland, it is planned that the infrastructure will be implemented in a decentralized way, i.e., using an access and control mechanism for federating existing records. In order to govern legal and financial aspects of the future nationwide EHR implementation, a bill was passed by the Swiss Federal Government in 2013 but left open questions regarding mandatory application.[13] The Federal Act on the Electronic Patient Record came into force on 15 April 2017, but the records were not universally available until 2020. It will be extended to birth centres and nursing homes in 2022. Both patients and clinicians can store and access health data in the records.[14]
Primary care
The ‘netCare’ scheme for minor ailments was introduced nationally in 2016. Pharmacists conduct a standardised triage and can prescribe medication. They can also have an unscheduled teleconsultation with a physician.[15]
According to official statistics in 2021, 19,532 hospitalisations were due to mental health illness and 19,243 for physical injuries.[16]
Statistics
Healthcare costs in Switzerland are 11.4% of GDP (2010), comparable to Germany and France (11.6%) and other European countries, but significantly less than in the USA (17.6%). By 2015 the cost had risen to 11.7% of GDP -the second highest in Europe.[17] Benefits paid out as a percentage of premiums were 90.4% in 2011. Total gross benefits per person and per year in 2011 were CHF 3,171 (PPP-adjustedUS$5,168), of which CHF 455 (PPP-adjusted $742) are cost sharing.[18]
According to the OECD Switzerland has the highest density of nurses among 27 measured countries, namely 17.4 nurses per thousand people in 2013.[19] The density of practising physicians is 4 per thousand population.[20]
In the 2018 Euro health consumer index survey Switzerland was placed first overtaking the Netherlands, and described as an excellent, although expensive, healthcare system.[21]
Switzerland has the highest rate of psychiatrists per population in the OECD (Iceland has half as many psychiatrists as in Switzerland and is ranked second).[22]
Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."
Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.
Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.
Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.
The Régie de l'assurance maladie du Québec is the government health insurance board in the province of Quebec, Canada. The no-longer-official English name is Quebec Health Insurance Board.
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.
Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.
The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately.
Examples of health care systems of the world, sorted by continent, are as follows.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
The nation of Liechtenstein has a universal health care system with decentralized, free market elements through mandated health insurance coverage for every person residing in the country.
The Swiss pension system rests on three pillars:
the state-run pension scheme for the aged, orphans, and surviving spouses ;
the pension funds run by investment foundations, which are tied to employers ;
voluntary, private investments.
The Federal Office of Public Health (FOPH) is the Swiss federal government's centre for public health and a part of the Swiss Federal Department of Home Affairs.
Visana, based in Bern, is a Swiss insurance company specialized in health insurance and accident insurance. The company group serves around 848,000 privately insured people and 16,500 insured companies, authorities and associations. In 2022, the Visana Group generated a premium volume of 3.6 billion Swiss francs with 1,450 employees.
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