How to Integrate Private and Public Actors in Health Care: the Swiss Answer

Transcription

1 AHIA 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

2 7.5 million 22.5 million 184/km 2 2/km 2

3 Gross national income per capita $ $ World Bank, International $, 2009

4 National Ranking in Happiness

5 Overall Views of Health Care System, 2010 Percent AUS SWIZ UK US Only minor changes needed Fundamental changes needed Rebuild completely Commonwealth Fund 2010 Internaltional Health Policy Survey

6 Let s move to Switzerland...

7 To do list Register at the local resident registration office Tax computation Sign up for an health insurance (98 % are insured)

8 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)

9 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

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11 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)

12 Financing of Swiss Health System (2009) Voluntary complementary health insurance 10% Other private 1% Other social insurances 7% Out-of-Pocket 21% Social security 3% Subsidies of hospitals etc. 16% Basic health insurance 42% Total: US$ 60 billion Co-payment 6% Premiums Social Health Insurance 30% Premium subsidies (federal, cantonal) 6%

13 What you get:

14 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

15 <3 miles <1/3 mile

16 Switzerland Health Data Comparison per million population Switzerland Australia Physicians Nurses Acute Hospital Beds MRI Units 14.2? CT Scanners 18.9?

17 Wait Times for Specialist Appointments Percent AUS SWIZ UK US Appointment: Less than 4 weeks Appointment: 2 months or more Elective Surgery: Less than 1 month Elective Surgery: 4 month or more Commonwealth Fund 2010 Internaltional Health Policy Survey

18 Cost-Related Access Problems in Past Year Percent AUS SWIZ UK US Did not fill prescription or skipped doses Had a medical problem but did not visit MD Skipped test, treatment or follow up Yes to at one of the above Commonwealth Fund 2010 Internaltional Health Policy Survey

19 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)

20 Leadership for Better Quality in Health Care Applied Leadership: Best practices in high performance project impact. Applied Leadership People Systems People Systems: Talent recruitment development, retention, and rewards. Enterprise Performance Performance Improvement Enterprise Performance: Hospital systems performance of OR, ED, Radiology, Laboratory, Pharmacy, Administration and Nursing. Performance Improvement: Project focused integrated performance with sustained gains.

21 GDP Growth of Healthcare costs United States + 2.5% / year Switzerland + 2.0% / year + 3 million US$ per day

22 Serious Problems Paying Medical Bills, by Income Above-average income AU SW UK US Below-average income Above Below Commonwealth Fund 2010 Internaltional Health Policy Survey

23 Problems with Health Insurance Percent AUS SWIZ UK US Spent a lot of time on paperwork or disputes over medical bills Health Insurance denied payment or did not pay as much as expected Yes to either Commonwealth Fund 2010 Internaltional Health Policy Survey

24 Health Professionals: too few, too unhappy.

25 Health Professionals: too few, too unhappy. Hope for change is here!

26 Thank you for your attention!

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28 Problems with Health Insurance Percentexperienced at least one of twoproblems Above-averageincome Below-averageincome AU SW UK US Above Below Commonwealth Fund 2010 Internaltional Health Policy Survey

29 Serious Problems Paying Medical Bills, by Income Above-average income AU SW UK US Below-average income Above Below Commonwealth Fund 2010 Internaltional Health Policy Survey

30 Wait Times for Specialist Appointments Percent AUS SWIZ UK US Appointment: Less than 4 weeks Appointment: 2 months or more Elective Surgery: Less than 1 month Elective Surgery: 4 month or more Commonwealth Fund 2010 Internaltional Health Policy Survey

31 National Ranking in Happiness

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33 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)

34 Financing of Swiss Health System (2009) Voluntary complementary health insurance 10% Other private 1% Other social insurances 7% Out-of-Pocket 21% Social security 3% Subsidies of hospitals etc. 16% Basic health insurance 42% Total: US$ 60 billion Co-payment 6% Premiums Social Health Insurance 30% Premium subsidies (federal, cantonal) 6%

35 LEAD: Leadership Engagement And Development Applied Leadership HARVARD UNIVERSITY People Systems HCC TMIT Enterprise Performance Performance Improvement

36 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.

37 Future Challenges Increase transparency in health outcomes Create integrated health care systems Provide enough health professionals Strengthen prevention and health promotion

38 Thank you for your attention!

39 Literature Statistik der obligatorischen Krankenversicherung 2007, Bundesamt fuer Gesundheit OECD Health Data URL: Federal Office of Public health. URL:

40 General government expenditure on health as percentage of total government expenditure

41 General government expenditure on health as percentage of total expenditure on health 100% 80% 45.80% 59.10% 60% 40% 20% General government expenditure on health Total expendit 0%

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43 Total expenditure on health as % of GDP

44 Financing of Swiss Health System (2009) Total: US$ 60 billion Sources: 1/3 basichealthinsurances 1/3 taxes 1/3 out of thepocket