Healthcare Systems Comparison
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Healthcare Systems Comparison
The healthcare system that is selected for comparison with the U.S healthcare system is the healthcare system of Switzerland and it is evident that these two countries rank highly due to their competitive and innovative economies (Schneeberger & Schwartz, 2018). Features that stand out include the developed private health insurance and federal insurance that cover universal health needs. Besides, Schneeberger and Schwartz note that the Swiss model of healthcare is exemplary even for the United States of America because it comprehensively caters to psychiatry and the treatment of substance abuse. Therefore, the merits of Switzerland’s healthcare system provide a fundamental step in developing better healthcare reforms while improving the setbacks that have been experienced in the same healthcare system.
As of 2018, the Swiss nation had more than 5,000,000 permanent residents. Federal administration subdivides the nation into three political levels namely communes, cantons, and the confederation (Jenni & Sennhauser, 2016). Switzerland is not a member of the European Union and joined the United Nations in 2000. The 26 cantons run independently apart from a few exceptional duties centrally performed by the federal government. Part of the canton’s healthcare responsibilities includes making plans on the delivery of healthcare services, partially financing hospital operations, and subsidizing part of the insurance premiums. There are more than 50 different insurance companies for residents to choose from. In Switzerland, it is mandatory for every inhabitant including foreigners to take healthcare insurance cover from the numerous options of competitive insurance companies that are available. Contrary to the U.S, Switzerland does not provide a national insurance service such as Medicaid for the financially disadvantaged individuals who cannot afford to cater for their healthcare. The general insurance subsidy is the same across all ages including that for the elderly. All the health insurance companies in Switzerland are expected to provide comprehensive coverage for a variety of medical services. Besides, workers neither receive healthcare insurance from their employers nor do they pay health taxation to the government (Schneeberger & Schwartz, 2018).
The general protective policy in Switzerland for employees’ health is that when accidents occur at work, employers must provide casualty insurance cover. Premiums are fixed for adults above 26 years old regardless of their underlying medical conditions. Since the private sector caters to the largest proportion of healthcare insurance in Switzerland, the government plays the regulatory role ranging from designing services offered to make decisions on the forms of payment. Legislative insurance benefit packages refund most physicians and medical specialists.
Besides, essential medications, physiotherapy as well as some of the preventive health measures in Switzerland are covered by the legislative insurance benefit packages. The reimbursement system in Switzerland has attracted most of the healthcare workers because in most instances patients are willing to access healthcare services but they do not readily cater for the medical expenses out of their pockets. Alternatives exist locally whereby residents sign up for insurance cover with health maintenance organizations providing up to 25% reductions on the total healthcare costs. Apart from the mandatory basic health insurance packages required by the government of Switzerland for all residents, individuals may opt for additional premium packages to supplement better treatment options including accommodation, a variety of hospital choices, and treatment offered by private physicians.
In 2004 Switzerland government introduced TARMED tariff system that caters to outpatient healthcare services. Premiums earn the insured individuals tariff points whose monetary values are determined by negotiations between insurers and the cantons (Schneeberger & Schwartz, 2018). Therefore, the points are used to redeem part of outpatient healthcare services making it more affordable for patients all over Switzerland. The supply of physicians working in the public and private sector in Switzerland is strictly regulated by policies both from the federal government and from the canton level. Regulation laws aim at reducing the chances of demand-induced healthcare spending by setting a threshold on the acceptable total number of healthcare providers at any given time.
Access Comparison Between the Healthcare System of Switzerland and the U.S
In Switzerland, access to healthcare for children is not only available at primary care centers but is also provided by pediatric hospitals dedicated to primary care such as emergency healthcare services as well as pediatric specialties and tertiary care in university-based teaching hospitals. Besides, most adult hospitals located all over Switzerland provide pediatric services for 30%-40% of the total number of children and adolescents who visit the healthcare facilities (Jenni & Sennhauser, 2016). Switzerland also offers mental health care for children at university-affiliated hospitals and cantonal psychiatric units for children and adolescents. Private practicing psychiatrists and psychologists for the children and adolescents also exist hence it is upon the decisions of the parents, guardians, or caregivers to select the services they can afford for their children.
Apart from child specialists, children’s health in Switzerland is also catered for by the services provided by nurses, occupational therapists, physiotherapists, social workers, speech therapists, nutritional advisors, midwives, and teachers of special needs among others (Jenni & Sennhauser, 2016). Jenni and Sennhauser noted that at the time when they were publishing their research, there were 985 primary care pediatricians and 5945 general practitioners who were caring for approximately 10% to 15% children and adolescents proportionately compared to the total number of patients served annually. The Swiss Society of Pediatrics (SGP) professionally organizes the country’s pediatricians and pediatric specialties according to their subspecialties into societies. The number of pediatric subspecialties in 2015 included 52 endocrinologists, 32 pediatric gastroenterologists, 46 pediatric cardiologists, 103 neonatologists, 23 pediatric nephrologists, 66 neuropediatric, 57 pediatric oncologists, 40 pediatric pulmonologists, 11 pediatric rheumatologists, 76 developmental pediatrics, and 50 emergency care pediatric specialists (Jenni & Sennhauser, 2016).
Pediatric coverage in Switzerland as well as in the United States changes constantly. For instance, 80% of preschoolers consult primary care pediatricians, general physicians take over the care of children from 11 years onwards. Pediatric service is not continuously guaranteed (Jenni & Sennhauser, 2016). In recent years, the number of visits recorded by Swiss general practitioners has reduced by 27% linked to the reducing number of general practitioners in the country. The reducing number of general practitioners is variable in rural and urban areas and is also different from one canton to another. If no action is taken to deal with the trending shortage of general practitioners in Switzerland, the number of visits recorded will reduce to 40% by the year 2030. A stable level of visits is recorded by the pediatricians in private practice because of the increasing number of pediatricians joining primary healthcare provision.
On the other hand, in the United States, access of children to healthcare can be assessed by analyzing the number of children who utilize the emergency department. A retrospective cohort study performed on data from emergency department databases of California, Utah, New York, Iowa, and Nebraska revealed that 6.7 million visits were made by children accounting for 22% of total hospital visits that year (Goto et al., 2017). The national annual number of visits made by children to the emergency departments in the United States is approximately 30 million. In the last decade, the visits increased by 14.4% according to the research findings of Goto and colleagues prompting the need for readiness for emergency care by pediatricians. Limited resources and workforce disparities continue to curtail pediatric readiness despite work being done to improve the access to emergency healthcare services by children in the U.S.
Out of the total number of emergency departments accessed by children in the United States, only 45% have plans of improving the quality of healthcare services that cater to children’s needs. 17% to 65% of these emergency departments have pediatric physicians or emergency nursing coordinators charged with the responsibility of training fellow staff and ensuring that appropriate equipment is in place to address healthcare for children according to the state policies (Goto et al., 2017). The emergency departments in the United States offer a dependable safety net, diagnostic, and treatment center for children. Approximately 40% who visit the emergency departments have a repeated visit in the year. A deeper analysis of the data revealed that socio-economic factors influenced the number of visits to the emergency department. For instance, the general observation was that children who had multiple emergency department visits were likely from racial and ethnic minorities. Most of this group of children depend on Medicaid cover and come from low median income households.
The US government targets to improve pediatric readiness through seven areas of focus. Coordinated administration, increasing the supply of physicians, nurses, and other health clinicians, improving the quality of services, improving patient safety, establishing policies, support services, improving equipment supplies, and medications for children (Goto et al., 2017). It is now a requirement for all emergency departments to have emergency care coordinators of pediatric subspeciality. Emergency residency training is set at a minimum of 20% encounter with pediatric patients. However, 50% of emergency departments are limited due to the high cost of training and inadequate educational resources.
Unemployed people have limited access to quality healthcare services in Switzerland because of the mandatory basic health insurance that does not offer flexible payment rates for premiums (Schneeberger & Schwartz, 2018). Therefore, the unemployed and low-income earners have a larger proportion of their income contributed to healthcare insurance coverages resulting in socioeconomic disparities between the rich and the poor. Besides, unemployed individuals in Switzerland cannot afford to pay for advanced insurance covers because of the higher costs. In the United States, unemployed individuals and low-income earners have improved accessibility to healthcare thanks to the Affordable Care Act (Kominski, Nonzee & Sorensen, 2017). Secondary to the implementation of the Affordable Care Act (ACA), 20 million previously uninsured individuals gained coverage. Besides, the number of poor uninsured families has been declining among Medicaid expansion states providing a sign of better access to healthcare services. Low and middle-income populations can therefore more comfortably afford and use preventive and outpatient services. The improved coverage of the poor under the Medicaid scheme after the implementation of ACA is because of the expanded access to Medicaid. Eligibility for Medicaid was expanded for individuals with incomes from 139% to 400% of the federal poverty level. However, high deductible Bronze plans still pose the threat of reducing access to healthcare services by poor populations in the United States (Kominski, Nonzee & Sorensen, 2017).
Retired individuals face financial difficulties depending on their socio-economic status in Switzerland because no special premiums offer reduced coverage plans for them (Schneeberger & Schwartz, 2018). Therefore, low-income individuals face financial challenges in affording healthcare services as compared to the rich. This factor has the disadvantage of increasing the financial disparity between the rich and the poor within society. In the United States healthcare system, more elderly retired individuals were able to be covered by the Medicaid insurance after the implementation of the affordable care act hence increasing the accessibility of the retired individuals to healthcare services (McInerney et al., 2020). Besides, adults aged 50 to 64 tend to be less healthy and previously had difficulty in obtaining health insurance coverage before Medicaid expansion.
From the above comparison, it is clear that coverage for medication for retired individuals is more expensive in Switzerland than in the United States because of the flexibility of Medicaid as compared to the private insurance options in Switzerland. In Switzerland, the requirements to get a referral are not restricted to primary care physicians (Tandjung et al., 2017). Since everyone must have health insurance in Switzerland, the insured is at liberty of choosing a healthcare plan that has reduced premium packages. Generally, Swiss patients in managed health care plans are likely to be referred more than in the US where a gatekeeping model exists. Tandjung and colleagues note that healthcare systems with a great gatekeeper role of primary care physicians have higher referral rates than the United States. Referral requirements to see a specialist in the US are therefore limited due to the gatekeeping model.
In both healthcare systems, the same preexisting conditions such as infectious diseases and non-communicable diseases such as heart disease, diabetes, and cancer are covered with slight variations. For instance, Switzerland's basic health insurance options cover all medical conditions except advanced dental services for most companies. In the United States, Medicaid covers inpatient hospital bills, doctor services, outpatient clinical care, laboratory services, ambulance services, and some prescription drugs. However, Medicare does not cover cosmetic surgery, missed appointments, dental services, over-the-counter medications, and annual physical checkups.
The first financial implication for patients concerning the healthcare delivery design in Switzerland is the increased financial burden, especially for low-income individuals. The Swiss healthcare system makes it compulsory to take health insurance cover from private companies with minimal subsidies hence poor citizens spend a big proportion of their income on premiums. Since the benefits of reduced healthcare costs are only experienced in the event of sickness, generally healthy individuals end up contributing more than they benefit from the compulsory insurance policy. Besides, healthcare disparities are increased because poor members of society cannot afford advanced healthcare insurance covers like the rich. The fixed rate of premiums across all ages regardless of the underlying medical conditions in Switzerland also exerts a disadvantage on individuals who are generally healthy because they end up spending more money to secure health insurance compared to the individuals who have more serious medical conditions. People with disabilities are also not exempted from expensive premiums yet they are physically or mentally disadvantaged as compared to the rest of the population.
Secondly, government policy in the United States positively impacts the financial status of poor citizens through the affordable care act. Consideration for inclusion of lower-income earners tends to reduce healthcare disparity because poor individuals are also able to utilize healthcare services at a reduced cost. The United States healthcare system federally sponsors healthcare insurance through provisions such as Medicaid hence is better placed to subsidize the citizens’ healthcare needs contrary to the Swiss healthcare system that offers no federally controlled healthcare insurance systems.
References
Goto, T., Hasegawa, K., Faridi, M. K., Sullivan, A. F., & Camargo, J., Carlos A. (2017). Emergency department utilization by children in the USA, 2010-2011. The Western Journal of Emergency Medicine, 18(6), 1042-1046. https://doi.org/10.5811/westjem.2017.7.33723
Jenni, O. G., & Sennhauser, F. H. (2016). Child Health Care in Switzerland. The Journal of pediatrics, 177S, S203–S212. https://doi.org/10.1016/j.jpeds.2016.04.056
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual review of public health, 38, 489–505. https://doi.org/10.1146/annurev-publhealth-031816-044555
McInerney, M., Winecoff, R., Ayyagari, P., Simon, K., & Bundorf, M. K. (2020). ACA Medicaid Expansion Associated with Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence from the Health and Retirement Study. Inquiry: a journal of medical care organization, provision and financing, 57, 46958020935229. https://doi.org/10.1177/0046958020935229
Schneeberger, A. R., & Schwartz, B. J. (2018). The Swiss Mental Health Care System. Psychiatric services (Washington, D.C.), 69(2), 126–128. https://doi.org/10.1176/appi.ps.201700412
Tandjung, R., Morell, S., Hanhart, A., Haefeli, A., Valeri, F., Rosemann, T., & Senn, O. (2017). Referral determinants in Swiss primary care with a special focus on managed care. PloS one, 12(11), e0186307. https://doi.org/10.1371/journal.pone.0186307