The latest attempt to stem rising healthcare costs has brought together strange bedfellows and has caused some unexpected U-turns. Voters will have the final say next month on whether to amend the federal law to include Managed Care.
After years of wrangling in parliament, politicians reached a compromise last year, with a majority agreeing to introduce Managed Care nationwide. The approach is aimed at reducing costs while improving quality of care.
But the system remains controversial, which is why it has run into opposition by the main doctors’ lobby – the Swiss Medical Association, along with trade unions supported by a majority of the centre-left Social Democratic Party and the rightwing Swiss People’s Party.
Together they collected more than enough signatures to bring the decision to a referendum on June 17.
In support of the Swiss Managed Care model is a multi-party alliance, which includes members of all the seven main political parties, consumer groups, the business community and family doctors.
And for an issue as complex as healthcare policy both sides are using slogans surprisingly simple.
“It’s hard to believe, but it is a fact: With the system of Managed Care we pay less and will get better quality,” says Ignazio Cassis, a leading promoter of the scheme and parliamentarian of the centre-right Radical Party.
Quite the opposite is true for Jacqueline Fehr, parliamentarian for the Social Democrats: “Managed Care results either in less care for the same price or the same care but for a higher price compared with now.”
The reform foresees the promotion of increased coordination and cooperation among healthcare providers – doctors and other medical personnel as well as pharmacies, hospitals and homes – with the aim of controlling costs and quality of care.
These health networks negotiate binding financial budgets and sign contracts with insurance companies.
As a rule a patient would go and see a primary physician, often a GP, who acts as gatekeeper and, if needed, makes referrals to specialists within the same medical network. An insured person joining a Managed Care network and waiving free access to a doctor of choice benefits from lower patient’s contributions to medical bills. Those who don’t, have to pay extra.
Good but costly
While Switzerland’s healthcare system is often praised as among the best in the world, it’s also one of the most expensive.
Very few experts would seriously challenge a perception that Switzerland’s ageing population, an increasing number of chronically ill people as well as medical progress will put the system under even higher financial strain in the future.
However, there is no consensus neither in the medical sector nor among politicians on how to reduce the financial burden.
Since health insurance coverage for basic medical services was made compulsory in 1994 numerous attempts have been made by the government, parliament and pressure groups to find a cure for rising costs.
At the launch of their campaign, the opponents of the Managed Care plan used strong language, accusing supporters of making bogus claims about higher quality and more efficiency, slamming the bill as a sham and scaremongering.
“The Managed Care plan cements a trend towards a two-tier medical system,” warns , a trade union representative and former Green Party parliamentarian.
The free choice of a doctor will become a privilege for those who can afford it financially since they have to pay extra – often a burden too heavy for those suffering from multiple illnesses, she cautioned.
Prelicz-Huber is concerned that the authorities will impose strict spending limits, undermining medical quality standards.
But doctors will also be hard hit, according to opponents, as strict budgetary constraints could stop doctors from providing the best possible treatment.
“These restrictions are unacceptable,” says Jacques de Haller, president of the Swiss Medical Association, the leading doctors’ pressure group.
However, the alliance of supporters of the Managed Care approach say it paves the way for healthcare provision with high quality standards, tailored to patients’ needs at an affordable price. No question of rationing medical services, they argue.
”We stop the waste of health insurance premiums and slow down the increase of health costs,” says Ruth Humbel, health expert and parliamentarian of the centre-right Christian Democratic Party.
Yvonne Gilli, a parliamentarian for the Green Party and a family doctor by profession, says teamwork among the different providers of the medical sector is the way forward towards more quality.
She says Managed Care means exchange information on patients to improve care, but it does require all the care providers of a particular network to share the same practice.
“The network is virtual, but quality service is mandatory.”
The supporters dismiss criticism that Managed Care plans in other countries had proven the ineffectiveness of such schemes to increase quality and curb costs. The Swiss system is not to be likened with that in the United States or Germany for instance, they say.
A comparison with Britain’s National Health Service is equally inappropriate as Swiss patients will continue to have a choice and because the medical networks are organised in regions and not by a central government.
Interior Minister Alain Berset, whose portfolio includes health matters, says Managed Care will result in more quality and transparency.
He says the about 90 existing Managed Care networks in Switzerland are successful, but efforts are needed to promote the system in rural regions, notably in the French-speaking part of the country.
Berset says 46 per cent of population are already taking part in some form of Managed Care when they consult their GP before seeing a specialist. The aim is to increase the figure to 60 per cent within three years, he adds.
He voted against the proposal when it was discussed in the Senate last year, but in his new role as a member of the government Berset is now convinced of the solid compromise agreed after years of negotiations following rejection of previous plans to rein in health spending.
The People’s Party as well as the Medical Association also changed their minds, turning an initial approval into rejection, while the Greens officially have refused to take sides, making transparent the rift within their own party ranks.
Key facts on Swiss healthcare
Health insurance is compulsory for all residents in Switzerland.
The insurance covers the costs of basic medical treatment and hospital stays, but the insured person pays part of the treatment, including an annual excess and a share of the costs.
Numerous political moves have been launched over the past decade to rein in health spending, including the funding of insurances and hospitals, limiting the number of new doctors and practices and cutting drugs prices.
Spending on public health reached SFr62.5 billion ($68.9 billion) in 2010 – the equivalent of 11.4% of Gross Domestic Product - according to latest official figures.
The figures put Switzerland among the countries with the highest health costs.
The rising premiums for health insurance have been a major concern for years. About 30% of the insured rely on financing subsidies for their premiums.end of infobox
Three votes on June 17
Apart from the ballot on the promotion of a Managed Care plan voters also have the final say on two other issues:
A proposal to grant tax breaks to prospective home owners
An initiative by conservatives to give citizens a greater say on foreign policy, curbing the powers of the government and parliament
Around 5.1 million citizens are eligible to take part in the ballots, including 164,000 voters - notably Swiss expats - who can use e-voting as part of an ongoing trial with the technology.
As a rule, nationwide votes take place four times a year on a broad range of issues. Parliamentary elections are scheduled every four years.end of infobox