Data from the Central Intelligence Agency (CIA-The World Fact book, 2011), reveal that “the United States has the most technologically powerful economy in the world” and that the U. S is “market-oriented, private individuals and business firms make most of the decisions in the economy”. The U. S. health care delivery system reflects the ideology of free enterprise espoused by American citizens. Health care is viewed and regarded “as an economic good and not as a public resource” (Shi & Singh, 2008).
The passing of the landmark Health Care Reform Bill into law by President Obama in March 2010 was a watershed in American health care history. The bill will ensure that 32 million more American citizens will have insurance coverage by the year 2016 Congressional Budget Office (CBO, 2010). The Swiss system is based upon “liberalism, private initiative, and is heavily regulated by the state” (Okma, et al. , 2010).
The system draws inspiration from European model of “managed competition” based on the premise that “the rules of the free market do not work adequately in the health care sector”. Okma, et al. , 2010, p. 144). In 1996 the Federal Health Insurance Law (FHIL) was passed which outlined an alternative approach to approaching competition by “shifting the competition mechanism away from the direct relationship between patients and their physician to the relationship between health insurer and insured as well as the relationship between health insurer and health care provider” (Okma, et al. , 2010, p. 144).
The Swiss health care system is also characterized by three important factors, “a strong decentralized political system based on federalism and the institutions of direct democracy, and a liberal economic culture, and a well-developed tradition of social security” (Okma, et al. , 2010),. This tradition of social security led to the rise to universal social insurances in the form of pensions, annuities for widows and orphans, disability insurance, unemployment insurance, family allowances, and medical care.
The Swiss system consists of 26 subsystems, connected to each other by the 1996 (FHIL). According to Okma, et al. , (2010), two other fundamental concepts worth mentioning are: “voice”- which is a federal means of direct democracy; and “exit”- which gives the regions “cantons” “recourse to “voice” when citizens feel that political decisions do not adequately reflect their regional preferences. The Cantons are responsible for health care regulation, supply and implementation (Okma, et al. , 2010).
Access and Utilization In the U. S there are significant barriers to entry at “both the individual and the system level” (Shi & Singh, 2008). According to Shi and Singh (2009), access to care is confined only to those with coverage from their place of work, government programs, and individuals who can pay for health services. Even those covered by insurance are still subject to deductibles and co-payments leading further to a reduction in utilization of services. Approximately 50 million American citizens are uninsured, and consequently have no access to routine primary health care.
The uninsured often wait until their conditions become acute and at that point seek for medical help a hospital emergency room. According to Shi and Singh (2008) the United States can be said to have some “form of universal catastrophic health insurance even for the uninsured” According to Shi and Singh (2008), it is precisely because of these barriers to access that puts the U. S behind other developed countries in measures of “population health, such as infant mortality and overall life expectancy”.
In the United States access is predicted by three factors: race, income, and occupation. Minorities, the disabled, rural residents, the low income are more likely to have challenges with health care access in the U. S. Children and adults with pre-existing condition are often denied coverage. The passing of the landmark Health Insurance Reform Bill into law by President Obama in March 2010 will extend coverage to an additional 32 million American citizens by the year 2016 Congressional Budget Office (CBO, 2010).
According to the CBO report (2010), the uninsured and self employed will be able to buy health insurance and subsidies will be available for families with income below the poverty level. Small businesses would be able to purchase insurance starting in 2014. Two provisions of the law are already in effect. Insurance companies cannot deny children coverage based on a preexisting condition and insurance companies are required by law to allow children to stay on their parent’s insurance plans until the age of 26.
CBO (2010) further explains that, starting in the year 2014 insurance companies cannot deny coverage to anyone individual with preexisting conditions. This bill is great step toward guaranteeing American citizens universal health care coverage and equity of access to health care. The law will make purchase of insurance mandatory. [pic] Switzerland guarantees all its citizens universal health care coverage.
The system is “characterized by substantial equity of access and widespread satisfaction of the population who feel the system is very responsive to patients’ preferences and offers ample freedom of choice” (Okma, et al. 2010, p. 149). According to (Okma, et al. , 2010), the Swiss system resembles a huge health supermarket where people freely shop around for health care providers of their choice. “Swiss patients have much wider access to diagnostic and therapeutic equipment than any other European nation” (Okma, et al. , 2010, p. 147).
The Swiss have access to a physician of their own choice, change providers at any time and are free to go to a specialist since gate keeping does not exist (Okma, et al. , 2010). Although the Swiss enjoy wider access to health care, Okma, et al. (2010) points out that the Swiss lack full access to full information regarding clinical quality, efficacy, and appropriateness of individual care providers since there is no public information regarding physician performance. “Such information is indispensable if patients are to exercise conscious choices and enjoy real decisional authority” (Okma, et al. , 2010, p. 148). Finance and Cost Compared to other developed countries, the Unites States spends 16. 3% of GDP on health which represents a large share of its economic resources (Shi & Singh, 2008).
According to Shi and Singh, (2008), the U. S. spent $2 trillion on health care which amounted to a per capita spending of $6, 697. In the United States, a third party instead of the consumers pays for the services utilized. The financing, insurance, payment, delivery functions of the U. S health care system is largely in private hands. Private health insurance is not mandatory in the United States. The U. S. government finances such public insurance programs as Medicare and Medicaid and government determines reimbursement rates for these programs.
Private insurance through employers accounts for “approximately 55% of total health care expenditures and the government finances the remaining 45%” (Shi & Singh, 2008, p. 11). The employee’s insurance premiums are paid through payroll deductions. Shi and Sing (2008) noted that in 2006 the average monthly cost including employer contribution amounted to $354 for a single plan and $957 for a family plan. In addition to payroll deductions, insured persons also pay out-of-pocket deductibles and co-payments. A deductible is paid before any benefits kick in for the insurance plan.
A co-payment is paid whenever services are rendered. Plans also incorporate a stop-loss mechanism which represents the maximum out-pocket amount an individual will pay for pay in a given year. The rationale for deductibles and co-payments is to decrease utilization of health care resources since having insurance may lead to moral hazard. The passing of the landmark Health Insurance Reform Bill into law by President Obama in March 2010 will extend coverage to an additional 32 million American citizens by the year 2016 Congressional Budget Office (CBO, 2010).
According to CBO (2010), a 3. 8% on investment income for families earning more than $250,000 per annum and $200,000 for individuals; starting in 2018 insurance companies will pay a 40% excise tax on high-end insurance plans worth above $27,500 for families and $10,200 for individuals; and a 10% tanning tax will be introduced. The 1994 FHIL made the purchase of insurance mandatory. According to (Uwe, 2004) Swiss insurance carriers are not allowed by law to make a profit except through supplementary benefits.
The average monthly family premium is $750, paid entirely by consumers. There are government subsidies for low-income citizens. Co-payments are 10 percent of the cost of services, up to $420 per year (Okma, et al. , 2010). According to Okma, et al. , (2010), in the Canto of Zurich monthly premium for an adult was $159 with a national average of $186. The government provides assistance to those who cannot afford the premiums. An individual is offered bonus policy if covered services were not utilized the previous year.
Quality and Outcomes Although the U. S. pends more on health care than any other country on earth, it “continues to rank in the bottom quartile among developed countries on outcome indicators, such as life expectancy and infant mortality. In fact its relative ranking has been declining since 1960”. (Shi & Singh, 2008). Traditional quality measures such as life expectancy and infant mortality have been used by the Organization for Economic Co-operation and Development (OECD), World Health Organization (WHO) and other international organizations in cross-national comparisons of health care systems across the world.
According to (Uwe, 2007), these indicators consist of numerous other variables besides health care and may not be reliable indicators of the health care performance of any country in cross national studies. Be that as it may, the United States has consistently lagged behind OECD countries in premature deaths that could have been avoided through primary and public health care measurers. In spite of enormous resources poured into the U. S. health care system, this has not resulted in positive health outcomes compared to the Swiss.
According to data compiled by CIA-The World Fact book (2011), infant mortality in the U. S was 6. 14 deaths/1,000 live births compared to 4. 12 deaths/1,000 live births in Switzerland. Life expectancy at birth in the U. S. was 78. 2 compared to 80. 97 among the Swiss (CIA-World Fact book, 2011). In the U. S. approximately 50 million people have no medical insurance, while Switzerland ensures that every citizen has access to health care. Health promotion and disease prevention has not been successful the U. S and mostly because of an ingrained cultural belief that give precedent to the medical model over health promotion and disease prevention.
Health care outcomes of the Swiss system are positive. According to (Okma, et al. , 2010), “there is a widespread satisfaction of the population, who feels that the system is very responsive to patients’ preferences and offers ample freedom of choice”. The same cannot be said of American healthcare consumers who are dissatisfied with the system. According to Uwe (2007), “the higher US health spending has not translated into consistently superior quality of care or greater satisfaction among patients, physicians, and hospital executives”.