AHIA 2010 9 November 2010 Sydney PRIVATE HEALTH / PUBLIC GOOD How to Integrate Private and Public Actors in Health Care: the Swiss Answer Prof. Dr. Thomas Zeltner Advanced Leadership Initiative, Harvard University, USA Former Secretary of Health and Director General of Swiss Federal Office of Public Health
7.5 million 22.5 million 184/km 2 2/km 2 Produced by Angela Rupp
Gross national income per capita $38.210 $ 41.830 World Bank, International $, 2009 Produced by Angela Rupp
National Ranking in Happiness Produced by Angela Rupp
Overall Views of Health Care System, 2010 Percent AUS SWIZ UK US Only minor changes 24 46 62 29 needed Fundamental changes 55 44 34 41 needed Rebuild completely 20 8 3 27 Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Let‘s move to Switzerland... Produced by Angela Rupp
To do list Register at the local resident registration office Tax computation Sign up for an health insurance (98 % are insured) Produced by Angela Rupp
Swiss Style Universal Coverage Everyone buys their own health insurance Everyone pays the same premium in a given insurance plan and in a given region Government enables lower income classes to participate Health insurance companies = Private, Non-Profit, (84 companies, 5 share 80% of the market) Produced by Angela Rupp
The Swiss System after the 1996 Reform • Universal coverage with a standardized benefit package through privately organized health insurances (Mandatory Basic Health Insurance) • Full mobility between health insurers: obligation to accept all applicants and to charge the same premium to everyone regardless of age, gender or medical history • Government subsidies for people with low income (40% of the population get subsidies) • Implementation of a risk equalization scheme Produced by Angela Rupp
Produced by Angela Rupp
Financing of Swiss Health System (2009) Total: US$ 60 billion (7’500 per person) Sources: 1/3 basic Health Insurances 1/3 Taxes (Federal and Cantonal) 1/3 out of the Pocket ( + ev. complementary Private Health Insurance) Produced by Angela Rupp
Financing of Swiss Health System (2009) Total: US$ 60 billion Out-of-Pocket 21% Co-payment Voluntary 6% complementary health insurance Basic health 10% Premiums Social insurance Health Insurance Other private 42% 30% 1% Premium subsidies Other social (federal, cantonal) insurances 6% 7% Subsidies of Social security hospitals etc. 3% 16% Produced by Angela Rupp
What you get: Produced by Angela Rupp
Assets of the Swiss Health System • Universal health insurance coverage, access to a broad benefit package without restriction • Health outcome indicators among the best worldwide and continue to improve (exceptions: mental health, substance abuse) • Few health inequalities compared to other OECD countries • High customers satisfaction, hardly any waiting time • Free choice of physician • No accumulated deficits • Health is one of the most important economic sectors • Excellent biomedical research Produced by Angela Rupp
<1/3 mile <3 miles Produced by Angela Rupp
Switzerland Health Data Comparison per million population Switzerland Australia Physicians 3900 3800 Nurses 15200 13900 Acute Hospital Beds 3400 2500 MRI Units 14.2 ? CT Scanners 18.9 ? Produced by Angela Rupp
Wait Times for Specialist Appointments Percent AUS SWIZ UK US Appointment : 54 82 72 80 Less than 4 weeks Appointment : 28 5 19 9 2 months or more Elective Surgery : 53 55 59 68 Less than 1 month Elective Surgery : 18 7 21 7 4 month or more Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Cost-Related Access Problems in Past Year Percent AUS SWIZ UK US Did not fill 12 4 2 21 prescription or skipped doses Had a medical 13 6 2 22 problem but did not visit MD Skipped test, 14 4 3 22 treatment or follow up Yes to at one of 22 10 5 33 the above Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Challenges for Swiss Health System • Demographic challenges • Quality & Transparency • Shortage of adequate data • Spending on health 10.8% of GDP • Shortages / migration of health care professionals • Predominance of health care in the health system (Prevention represented 2.1% of the Swiss health expenditures) Produced by Angela Rupp
Leadership for Better Quality in Health Care Applied People Systems: Talent Leadership Applied Leadership: recruitment development, Best practices in high retention, and rewards. performance project People impact. Systems Enterprise Performance Performance Improvement Enterprise Performance: Hospital systems Performance performance of OR, ED, Improvement: Project Radiology, Laboratory, focused integrated Pharmacy, Administration performance with and Nursing. sustained gains. Produced by Angela Rupp
Growth of Healthcare costs GDP 18.0 United States 16.0 + 2.5% / year 14.0 12.0 10.0 Switzerland 8.0 + 2.0% / year 6.0 + 3 million US$ per day 4.0 2.0 0.0 1960 1970 1980 1990 2000 2010 2020 Produced by Angela Rupp
Serious Problems Paying Medical Bills, by Income Above-average income 40 Below-average income 29 31 30 20 Above 20 15 13 11 10 Below 4 5 0 AU SW UK US Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Problems with Health Insurance Percent AUS SWIZ UK US Spent a lot of time on 6 6 3 17 paperwork or disputes over medical bills Health Insurance denied 11 10 2 25 payment or did not pay as much as expected Yes to either 14 13 5 31 Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
• Health Professionals: too few, too unhappy…. Produced by Angela Rupp
• Health Professionals: too few, too unhappy…. Hope for change is here! Produced by Angela Rupp
Thank you for your attention! Produced by Angela Rupp
Produced by Angela Rupp
Problems with Health Insurance Percentexperienced at least one of twoproblems Above-averageincome Below-averageincome 40 29 31 30 20 Above 20 15 13 11 10 Below 4 5 0 AU SW UK US Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Serious Problems Paying Medical Bills, by Income Above-average income 40 Below-average income 29 31 30 20 Above 20 15 13 11 10 Below 4 5 0 AU SW UK US Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
Wait Times for Specialist Appointments Percent AUS SWIZ UK US Appointment : 54 82 72 80 Less than 4 weeks Appointment : 28 5 19 9 2 months or more Elective Surgery : 53 55 59 68 Less than 1 month Elective Surgery : 18 7 21 7 4 month or more Commonwealth Fund 2010 Internaltional Health Policy Survey Produced by Angela Rupp
National Ranking in Happiness Produced by Angela Rupp
Produced by Angela Rupp
Characteristics of the Swiss health system National & 26 cantonal governments share competences in health policy Predominance of health care over prevention and health promotion (2.2% of health budget of 60 billion US$; 10.8% of GDP) Universal coverage with an extensive benefit package through privately organized health insurances Combination of private competition and state regulation (“regulated market model”) Historically grown highly fragmented care system (e.g. 350 hospitals and mostly individual physician practices) Produced by Angela Rupp
Financing of Swiss Health System (2009) Total: US$ 60 billion Out-of-Pocket 21% Co-payment Voluntary 6% complementary health insurance Basic health 10% Premiums Social insurance Health Insurance Other private 42% 30% 1% Premium subsidies Other social (federal, cantonal) insurances 6% 7% Subsidies of Social security hospitals etc. 3% 16% Produced by Angela Rupp
LEAD: Leadership Engagement And Development HARVARD Applied UNIVERSITY Leadership People Systems Enterprise Performance Performance Improvement HCC TMIT Produced by Angela Rupp
Overall costs could be lowered if the Swiss public wanted to: 100% enrolled in HMOs, costs would drop 39%. If 100% enrolled in high deductible, costs would be 18% lower. Produced by Angela Rupp
Future Challenges Increase transparency in health outcomes Create integrated health care systems Provide enough health professionals Strengthen prevention and health promotion Produced by Angela Rupp
Thank you for your attention! Produced by Angela Rupp
Literature • Statistik der obligatorischen Krankenversicherung 2007, Bundesamt fuer Gesundheit 2008. • OECD Health Data 2009. URL: http://stats.oecd.org/Index.aspx?DatasetCode=HEALTH • Federal Office of Public health. URL: www.bag.admin.ch/org/index.html?lang=en Produced by Angela Rupp
General government expenditure on health as percentage of total government expenditure Produced by Angela Rupp
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