Saturday, August 28, 2010

Healthcare competition 1: Switzerland

Most healthcare systems in rich countries are nationalized, socialized and monopolized. That is, a national government healthcare agency monopolizes or near-monopolizes (only a token of private health insurance competitors) the system. A centralized and socialized system like that will have difficulty adjusting to varying needs of the patients.

Switzerland's style is different. There is no national monopoly health insurance system.

See this brief description from a good article:

http://www.spectator.co.uk/essays/6142898/part_3/swiss-welfare-runs-like-clockwork.thtml


Swiss welfare runs like clockwork

17 JULY 2010
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There is plenty to learn from the way healthcare, education and social security are managed in Switzerland, says James Bartholomew
Switzerland has arguably the most successful system of healthcare in the western world. It is an insurance system with a twist. You are obliged to take out health insurance but you can choose which company to use. There is no state monopoly. So you can choose an insurance group which is connected to your line of work. Or you could go with a trade union-run insurance co-operative. Or a private, commercial company. That means there is some competition among these companies to provide the best possible service for the lowest possible price. Then these companies, in turn, have some choice over which doctors and hospitals they commission to work for them. So again, the doctors and hospitals have to compete to offer the best facilities and treatment at the lowest possible cost. Poorer people get credits which enable them, too, to choose insurance.

The Swiss health service is decidedly superior to that in Britain, too. It has more doctors per capita, more advanced scanners, better results in treating cancer and so on. All right, it is not perfect. People get treated for free, effectively, and, since the service is easily available and good, they tend to overuse it. Thus the costs have been rising worryingly, as with other social insurance systems. The Swiss model remains, however, one of the best around. It provides less of a barrier to employment than most social insurance systems. The cost of the premiums is borne by individuals, not shared among companies as it is in Germany.

Swiss schools are also better, on average, than British ones. That has, again, surely got a lot to do with local control — not the fake kind to which we have become accustomed to. Primary schools are run by little communes and secondary schools and universities by the cantons. It means there are villages where the officials in charge of a school will all know the headmaster and many of the students. There is much less wasteful bureaucracy and much more direct accountability.

So what happens if you are, say, a young mother in Switzerland with a little baby but no husband or similar on the scene and nowhere to live? There is no countrywide answer to this question because it is not dealt with on a national basis. It is not even dealt with by one of the 26 cantons. It is dealt with by your local commune. There are 2,900 of these and their population can be anything from 30 to 10,000 or more.

Officials from this ultra-small local government will come and investigate your individual circumstances. The father will be expected to pay. The mother’s family, if it is in a position to, will be expected to house and pay for her. As a last resort, the young mother will be given assistance by the commune. But the people who pay the local commune taxes will be paying part of the cost. You can imagine that they will not be thrilled at paying for a birth or separation that need never have taken place. Putting yourself in the position of the mother — and perhaps the father — you can imagine that you will be embarrassed as you pass people in the street who are paying for your baby. Instead of feeling you have impersonal legal rights, as in Britain, you are taking money from people you might meet at your local cafĂ©. No wonder unmarried parenting is less common.

A similar system applies if you need means-tested benefits. Those made redundant receive, for a while, generous unemployment insurance payments from the cantonal governments. But once these payments run out, people depend again on their local commune. You would be cautious of claiming fraudulently because, if you worked in the black economy, your chances of being spotted would be high. And so it is that Switzerland has the second highest rate of male employment in the OECD. Britain’s rate is about 50 per cent worse.

Switzerland has arguably the most successful system of healthcare in the western world. It is an insurance system with a twist. You are obliged to take out health insurance but you can choose which company to use. There is no state monopoly. So you can choose an insurance group which is connected to your line of work. Or you could go with a trade union-run insurance co-operative. Or a private, commercial company. That means there is some competition among these companies to provide the best possible service for the lowest possible price. Then these companies, in turn, have some choice over which doctors and hospitals they commission to work for them. So again, the doctors and hospitals have to compete to offer the best facilities and treatment at the lowest possible cost. Poorer people get credits which enable them, too, to choose insurance.

The Swiss health service is decidedly superior to that in Britain, too. It has more doctors per capita, more advanced scanners, better results in treating cancer and so on. All right, it is not perfect. People get treated for free, effectively, and, since the service is easily available and good, they tend to overuse it. Thus the costs have been rising worryingly, as with other social insurance systems. The Swiss model remains, however, one of the best around. It provides less of a barrier to employment than most social insurance systems. The cost of the premiums is borne by individuals, not shared among companies as it is in Germany....

The important key is there: there is competition among various healthcare providers, the people have a choice which system or company can provide them the best service based on their specific health needs and personal or corporate budget. And there is competition too among physicians, clinics and hospitals, to be employed or accredited by the more well-known private healthcare groups.

If something is given for free, expect an abuse, where demand is larger than the supply. To reduce or control such abuse, encourage and allow market segmentation among patients within the same healthcare provider. That is, healthcare company A can provide 10 or more different healthcare services at 10 or more different costs.

For instance, Package A is worth only $500 per year and coverage is only for annual general check up plus limited physician visit, no diagnostic test coverage. Package B is worth $750 for wider healthcare coverage, up to Package J, and so on.

This way, those who take care of their body and live healthy lifestyle will get only the cheaper package as they know that they are less likely to get sick and less likely to visit a physician too often. Those who live unhealthy lifestyle, or love risky adventures, or those who work in physically and mentally-stressful work, should get the more expensive package as they are likely to visit physicians more often than the average guys.

There is incentive for people to be more responsible about their body. There is no incentive for people to be irresponsible about their body because there is always a state-run healthcare system that assures people that "health is a right."

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