Health Care Lessons from Switzerland

Abstract

This paper is part of a series that examines the way health services are funded and delivered in other nations. The nations profiled all aim to achieve the noble goal of Canada's health care system: access to high quality care regardless of ability to pay. How they organize to achieve that goal differs markedly from the Canadian approach. So do their performances and results.

The focus of this paper in the series is Switzerland. The Swiss health care system has previously been identified as a system that provides some of the best outcomes when compared with other developed nations that maintain universal approaches to health care insurance. The Swiss health care system has also been identified as highly responsive and one in which waiting times are not considered to be a problem. A careful examination of the Swiss health care system will provide insights and information that will be useful in the Canadian debate over the future of Medicare.

Health system performance — Canada compared to Switzerland:

Looking at factors such as the ability of the health care system to provide healthy longevity, low levels of mortality from disease, and effective treatment for both chronic and terminal illnesses, it seems the Swiss health care system broadly performs at a level similar, if not superior, to that in Canada. Specifically, the Canadian health care system outperforms Switzerland's in five of 13 measures examined: one of three measures of in-hospital mortality, two of three measures of primary care performance, and two of six measures of patient safety. Conversely, the Swiss health care system outperforms Canada's in eight measures: infant mortality, two of three measures of in-hospital mortality, one of three measures of primary care performance, and four of six measures of patient safety.

Lessons for Canada:

The combination of superior access to health care and potentially superior outcomes from the health care process with fewer resources suggests there is much Canadians can learn from the Swiss model. It must be recognized that emulating the Swiss approach to health care would require substantial reform of the Canadian system including, most significantly, a shift from a tax-funded government insurance scheme to a system of independent competitive insurers within a statutory enrollment framework. While that may be a large undertaking, the evidence suggests there may be significant benefits to doing so.

The Swiss health care system departs from the Canadian model in the following important ways:

•Cost sharing for all forms of medical services

•Private provision of acute care hospital and surgical clinic services

•Activity-based funding for hospital care

•Permissibility of privately funded parallel health care

•A system of statutory independent insurers providing universal services to their insured populations on a largely premium-funded basis (commonly known as a social insurance system), with individual choice of insurers and some personalization of insurance coverage

Keywords: health, medical policy in Switzerland, medical policy in Canada, medical economics in Switzerland