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Swiss Health Care System

Switzerland has a permanent resident population of eight million and is structured as a federal directorial republic with 26 cantons, which are independent in all matters that are not specifically designated as the responsibility of the federal government. Switzerland has a private health care insurance system, with federally mandated insurance, and the cantons are responsible for the planning and delivery of health services, partial financing of hospitals, and provision of subsidies for insurance premiums . Residents can choose from about 60 different insurance companies. Every Swiss resident, including foreign citizens, is required to acquire statutory health insurance from competing insurance companies. In the case of financial hardship, local authorities will cover the expenses on the basis of income (subsidies). There is no government insurance program, such as Medicaid, for persons whose income and resources are insufficient to pay for health care. In Switzerland, the elderly, like the rest of the population, receive their care via these private insurers and do not receive any special financial considerations beyond the general subsidy . Swiss health insurers are required to offer comprehensive policies that cover a wide range of medical care. Employers do not provide health insurance for their workers, nor do they pay a tax for health care. However, employers must provide casualty insurance for accidents. Premiums for adults over the age of 26 do not vary by age or health status.

The Swiss federal government regulates the health insurance market, including services covered and form of payment. Statutory health insurance benefit packages reimburse most primary care physicians and specialists and cover an extensive list of medications, physical therapy, and some preventive measures. Most health care providers in Switzerland stay within the reimbursement system because patients are readily able to access care and are unwilling to pay out of pocket. As a less expensive alternative (reductions up to 25%), residents can sign up for coverage with a health maintenance organization. In addition to the mandatory basic health insurance, residents may purchase complementary and supplementary premium packages to cover improved accommodation and free choice of hospital and treating physician (5).

To influence outpatient utilization and spending, the Swiss government introduced in 2004 the TARMED (French, tarif médical) tariff system for outpatient health services. It encompasses about 4,000 tariff positions, which label and assess services provided by physicians. The pricing of medical services with TARMED is calculated consistently throughout Switzerland with so-called tariff points. The canton and the health insurers negotiate the monetary value attributed to the tariff points for private and public institutional outpatient services (6). Also, in an attempt to regulate the supply side of health care, the Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care providers. The cantons have the jurisdiction to implement this law or to allow exemptions in case of a shortage of physicians in primary care or in certain specialties (7). Health insurers must provide mandatory insurance plans with different types of gatekeeping, such as health maintenance organizations, mandatory first visits to a designated primary care physician, or annual deductibles ranging from US$300 to US$2,500 a year.

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