Switzerland’s healthcare problem

Switzerland’s healthcare system is amongst the world’s best, when you need it, and the worst if you don’t need it or can’t afford it. Insurance premiums finance the health system. As with all insurance there is cross-subsidisation. But with Switzerland’s healthcare, it’s the poor subsidising the rich.

Blood gc27700b1f 640Switzerland’s healthcare is the world’s second most expensive, after America. It costs the economy 12.1% of GDP[1]Health at a Glance: Europe 2020 pg162. The problem is: who is footing the bill? Switzerland has adopted mandatory health insurance (MHI): every resident is legally obliged to have health insurance and it’s prohibitive, especially for the poor. 

Although there are subsidies for the poorest,  there is a significant number of Swiss for whom the premiums are unaffordable[2]Health2030 – the Federal Council’s health policy strategy for the period 2020–2030 pg 22.

Then there are the out-of-pocket (OOP) payments when there are claims. The minimum copayment is 10% and the minimum deductible is CHF300. But the deductible amount is based on the premium, so to make the premiums more affordable, most people have a much higher deductible. Except for the rich and the chronically ill, most Swiss have  catastrophe health insurance. For the bottom quintile healthcare represents 22% of expenditure[3]OECD Reviews of Health Systems: Switzerland 2011 pg 70.

Some people have to choose between bread and health insurance, and by law, you must pay the insurance.

Leading a healthy life, eating well and exercising regularly has proven health benefits. Cardiovascular diseases (CVD) are responsible for just over 30% of the country’s deaths. CVDs, Cancers (slightly less than 30%)[4]Switzerland Health system review pg 1, respiratory ailments and diabetes are far less likely for people with a healthy lifestyle.

In a survey conducted in 2017, 47% of the respondents confirmed their willingness to make their exercise data available if this resulted in lower health insurance premiums[5]FORUM DES 1OO Sophia 2017 pg 9.

The rates of obesity are soaring. Between 1992 and 2017, obesity has increased from 5% to 11% of the population[6]Swiss Health Survey 2017: overweight and obesity. Over 31% of Swiss are overweight or obese. Obesity is linked to CVDs, hypertension, type 2 diabetes, High LDL cholesterol, low HDL cholesterol, gallbladder disease, osteoarthritis, sleep apnea, low quality of life, and many forms of cancer[7]The Health Effects of Overweight and Obesity. Obesity is a complex condition, and there is no simple solution. Physical activity is recommended as part of a comprehensive weight loss therapy that leads to pronounced health improvements for people who are overweight[8]Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults pg 46.

But in Switzerland’s health insurance system, leading a healthy life does not result in lower premiums or rebates.

The inequities of Switzerland’s healthcare system are well documented. Addressing the inequity is an objective of the Federal Office of Public Health[9]Health2030 – the Federal Council’s health policy strategy for the period 2020–2030 pg 24.

There is little evidence of progress. 

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HRV Health is a Swiss organization dedicated to the promotion of a healthy lifestyle over medication as the global solution to the healthcare crises. If you share this approach, please vote.

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