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Opinion


Single-payer health insurance: freedom of choice – yes or no?


By Thomas Zeltner



On September 28, the Swiss will vote on an initiative for a single-payer health insurance fund. Thomas Zeltner, former director of the Federal Health Office, says the country's health care system is a success story, pointing to the diversity of its services and the free choice of a doctor as a guarantee of high quality.

By Thomas Zeltner

The Swiss health care system is one of the finest in the world. Of course, even the best system must continually evolve. But introducing a single-payer health scheme is not the way to go about this. The Swiss have already voted on a single-payer national insurance three times, most recently in 2007. Each time, they clearly rejected the proposal. Yet they are once again being called upon to vote on such a scheme.

Thomas Zeltner was director of the Federal Health Office from 1991 to 2009. He is currently an advisor to the director-general of the World Health Organization (WHO) and the Swiss cabinet. Zeltner is also president of the KPT health insurance company and the blood donor service (Swiss Transfusion) of the Swiss Red Cross.

Two levels of health insurance

Every person who lives in Switzerland is obliged by law to purchase basic health insurance from a Swiss provider. As the name suggests, this covers basic medical needs, the scope of which is set by binding regulations in the Law on Sickness Insurance. Although the benefits provided by this insurance are the same throughout the country, the various health insurance companies differ considerably in their delivery of these services.

For example, those who want more comprehensive coverage can also purchase a supplementary insurance that reimburses for services beyond the scope of the basic insurance. This can be bought at the same firm that provides the basic insurance or at a rival insurer. Among other things, supplementary insurance can cover additional services, more perks during a hospital stay, extended services in outpatient care such as check-ups, contributions to the purchase of glasses and contact lenses, and services abroad in the form of travel and holiday insurance.

Swiss health system: a success story

The Swiss health care system is a world leader. More than three-quarters of the population are satisfied with the current system.

This is no accident. International comparisons show that access to health care in Switzerland is better than in any other country in the world. Patients receive an appointment with their general practitioner faster, and are treated swiftly in an emergency or in the event of an accident. Those who suffer from cancer receive the necessary treatment quickly. This is significant, because in such cases a rapid response time can be absolutely decisive.

It is no wonder that the Swiss are more satisfied with their medical care than people in any other country in the world.

This is a strong argument for our current system: a system whose basic elements we definitely want to preserve. Naturally, the Swiss health care system must also evolve. For example, the increase in the number of chronically ill people requires new models of care and more disease prevention.

Initiative for a single health insurer in Switzerland

The initiative for a single national health insurer was launched by an umbrella group of patient pressure groups, health organisations, political parties, trade unions and professional and industry associations. They see the Swiss health system itself as a patient in need of a cure.

But a glance across the border suffices to show that it is precisely the state-run single payer systems that have accumulated billions in debt, as in neighbouring France for example. In Austria, the health care debt is being restructured with a taxpayer-funded rescue package. And in Britain, access to some medical services is not guaranteed to all. A standard operation to treat cataracts, for example, is paid for only under certain conditions.

And the Swiss health care system? It is debt-free and guarantees high-quality health services to all residents regardless of age, income or condition of health.

Keep freedom of choice

The Swiss population today enjoys a great privilege: they are able to choose their own doctor and thus their own medical treatment on their own. This means that individuals are free to choose to whom they want to entrust their health care. For such an important and personal matter this is a priceless advantage.

Furthermore, people are also able to choose their own health insurance provider and insurance model. Why is this important? For two reasons: first, the delivery of services offered by the providers differs quite significantly in part; and second, there are also diverse models for delivery of the basic obligatory insurance.

Keep diversity

But first things first. Some health insurers refund invoices within two weeks, while others might do so at the end of the year or when the annual deductible is met. Some have an insurance card that covers medicine bought in a pharmacy, while others mandate payment upon purchase. Some insurers have online platforms to make communication and the organisation of insurance business easier, while others do not offer this service.

Why is that? Quite simply, the fact of competition pushes Swiss health insurance companies to provide the best for their customers. In this case the best means the best services and the best, most innovative products.

The diversity of offerings in insurance products is equally important – also in the basic insurance. The Swiss population does not consist of unit customers, but of real people who have different needs and preferences.

Those who place value on being treated by a trusted doctor and who want in addition to save on premiums will opt for a general practitioner model. Those who want to benefit from the advantages offered by a group practice will choose a cheaper HMO model. And those who do not want restrictions on their choice of doctor will choose a classic basic insurance. All of this is possible. Still.

So what is the vote on September 28 really about? It is about keeping a well-functioning health system that the vast majority of the population is satisfied with. It is about preserving the variety that we currently enjoy so that healthy competition can take place which maintains the quality of the services for the benefit of the insured. And it is particularly about maintaining what the people in Switzerland have always held dear to their hearts: their freedom to choose.

Thomas Zeltner

Thomas Zeltner was director of the Federal Health Office from 1991-2009. He is currently an advisor to the director-general of the World Health Organization (WHO) and the Swiss cabinet. Zeltner is also president of the KPT health insurance company and the blood donor service (Swiss Transfusion) of the Swiss Red Cross.

In addition, he is a member of the board of the Swiss Academies of Arts and Sciences. Along with Charles Denham, he is co-founder of the Global Patient Safety Forum.

Zeltner teaches at the Graduate Institute of International and Development Studies at the University of Geneva and at Harvard University in Boston. He is a Swiss physician and a lawyer, graduating from the University of Bern.

Opinion series
swissinfo.ch publishes op-ed articles by contributors writing on a wide range of topics – Swiss issues or those that impact Switzerland. Over time, the selection of articles will present a diversity of opinions designed to enrich the debate on the issues discussed.


By Thomas Zeltner, former director of the Federal Health Office
(Translated from German by Kathleen Peters)