Health insurance plan to face test at polls
Voters on Sunday decide on a proposal to introduce a single health insurance company in Switzerland and premiums based on income and wealth.
The plan, which is supported by the centre-left but opposed by the centre-right as well as the business community, parliament and the government, is the latest in a series of attempts to cut increasing costs, notably health premiums.
There are currently 87 private insurers providing mandatory coverage for basic health care for residents in Switzerland under a 1996 law. But health premiums have soared spectacularly over the past decade.
More than 100,000 people are no longer covered because they haven’t paid their premiums.
The centre-left Social Democrats and the Greens say a single health insurance scheme would boost the efficiency of the system and allow annual savings of at least SFr300 million ($245 million) in administrative costs.
“The multitude of insurance firms creates nothing more than high costs, because they all provide the same service and try to win as many young and healthy clients,” said Social Democratic Party president and parliamentarian Hans-Jürg Fehr.
Expensive premium
Franziska Teuscher of the Green Party says the current funding system for the health insurers is unbalanced, since many clients – about 20 per cent – claim state subsidies to pay for the premiums.
She denies allegations that a single insurer would necessarily take advantage of its monopoly.
“The old age pension, the unemployment and the national accident insurance schemes are successful examples,” she told swissinfo.
But opponents argue a single insurance system would lead to complacency.
“A monopoly will create a two-tier system, where only the wealthy can afford to take out additional private insurance coverage,” says People’s Party parliamentarian Toni Bortoluzzi.
The current system of subsidies provides sufficient financial backing for clients with low income, according to Bortoluzzi.
Liberal Party parliamentarian Claude Ruey dismisses claims that the initiative could help bring down rising health expenditure.
“It’s a bit ridiculous to say a single insurer would have a significant impact on costs.”
Rein in costs
The proposal to merge the insurance companies and introduce premiums based on wealth and income is the latest in a series of attempts over the past ten years to rein in spending on health care.
Switzerland has the most expensive health system in Europe, according to an international comparison. It spent 11.6 per cent on health in 2005, ahead of Germany and France, but behind the United States.
There was uncertainty ahead of Sunday’s ballot to what extent the middle class would benefit – or lose out – under the proposed single insurance plan. Proponents appeared to disagree on how to plug an expected shortfall in financial contributions from people taking out insurance.
Both sides referred to health systems in other countries to make their arguments, but experts point out that any direct comparison with the Swiss scheme is difficult.
Denmark and Austria, for instance, have single health insurance companies, but unlike Switzerland they limit the choice of doctors.
Latest opinion polls indicate voters will overwhelmingly reject the initiative, as they did a previous attempt in 2003.
swissinfo, Urs Geiser
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People’s initiative
In 2005 Switzerland spent SFr52.9 billion ($43.2 billion) or 11.6% of GDP.
The average for OECD countries is 8.8%.
The US spends 15.3%, Germany 10.9% and France 10.5% on health.
From 2001 health costs rose on average 4.1% a year in Switzerland.
The people’s initiative for a single health insurance company and premiums based on income and wealth was launched by a family association in western Switzerland.
The proposal has the support of the political left, some trade unions and doctors’ associations.
Parties from the centre-right, the right, the business community, government and parliament as well as the health insurers have come out against.
The proposal is an amendment to the Swiss constitution and needs a majority of voters and cantons to pass at the ballot box.
A 1996 law obliges every resident in Switzerland to take out basic health care insurance covering a range of services. The insurance is private and the insured person can currently choose among 87 companies.
The insurance companies are financed by per-capita contributions by clients and excess payments, as well as state funds through premium reductions for those on low incomes.
Unlike many other European countries, health insurance premiums in Switzerland are not calculated according to wealth and income.
The government has given the cantonal authorities some funding to help reduce premiums for those on low incomes (30% of those insured).
The premiums, based on a per-capita system, vary from canton to canton and differ from one insurance scheme to another.
About 120,000 people – 1.6% of the population – are not covered by the insurance, because they can’t afford or refuse to pay the premiums.
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