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Politics : Politics for Pros- moderated -- Ignore unavailable to you. Want to Upgrade?

To: TimF who wrote (112086)	5/1/2005 12:37:54 PM
From: LindyBill	Read Replies (2) \| Respond to of 793955

This is the best I have been able to come up with, knowing that some sort of "national" health insurance is inevitable. It will be written by congress, so best to pick the one that the right likes, instead of getting the mess the left wants. What I am proposing is a version of the Swiss system, which seems to be the best hybrid out there. I am sure all the questions we have have been "asked and answered" by the Swiss during their experience with it. Here is what I have found so far. This is an explanation for foreigners living there. Health insurance in Switzerland: General principles cagi.ch Are "internationals" obliged to take out Swiss health insurance? Generally, basic health insurance is mandatory for everyone resident in Switzerland. However, consular employees, permanent mission and international staff as well as their families are not obliged to take out health insurance here, though they may decide to do so voluntarily. However, without Swiss insurance cover, the patient must pay all medical expenses. Definitions Health insurers provide mandatory basic health insurance. They are non-profit organizations recognized by the Swiss Federal Department of Home Affairs. They also offer supplementary insurance cover. Mandatory basic health insurance (also known as basic insurance): guarantees access to high-quality healthcare and a broad range of services, identical for all insurance holders (without reservations concerning pre-existing conditions and with an identical premium range for insurance holders covered by the same health insurer). Supplementary insurance: this is optional. It covers specific needs (private or semi-private rooms) and services (naturopaths, dentists, etc.). In principle, the premium corresponds to the risk that the insurance holder represents for the insurer. The insurer can refuse to cover an applicant or make reservations based on the applicant's existing state of health. Initial deductions and other methods of reducing basic premiums All basic insurance assurance carries a mandatory minimum annual deduction (which varies each year, e.g. it was CHF 230.- in 1998). You can lower your premiums by accepting a higher deduction (of CHF 600.- or CHF 1500.- for example). You should also seek information on the reductions available for accepting a limited choice of physician and hospital (HMO collectives). What does mandatory basic insurance cover? * In principle all treatments carried out by a physician * The cost of hospital treatment (public ward)* (the hospital or clinic must be listed by your canton of residence. Your health insurer can supply you with this information). Medication prescribed by a doctor included in the "Specialty List" * Other services subject to conditions regarding prevention and other healthcare: vaccinations, maternity care, optical care, home nursing, etc. (information is available from health insurers). However, please note that you are responsible for 10% of the expenses not included in the franchise amount. You can take out additional or supplementary health insurance only, provided that you hold basic health cover from a recognized insurer. Health Profile for Switzerland frommers.com Health care in Switzerland is available to all, and is provided by private practice doctors in the community, and by public and private hospitals. Care is financed mostly by compulsory health insurance and patient co-payments. The quality of care is comparable to that in the United States. Americans can access the Swiss health system without difficulty. For emergency care they need only to call an ambulance (Tel: 144) or go directly to the Emergency Department of the nearest public hospital. For non-emergency care one can go to the office of any general practitioner (GP) or specialist, or in larger cities to the polyclinic (multi-specialty clinic) at the public hospital. In all instances, payment is expected on completion of service provided. Though German, French, and Italian are the dominant languages in Switzerland, most professional people understand English. Americans should, therefore, have little difficulty in communicating with doctors and hospital personnel. The Swiss health system operates on a decentralized basis in each of the Swiss political jurisdictions known as cantons and each canton may, as it chooses, delegate responsibilities to local governments. Swiss law requires all people to have health insurance including visitors who expect to be in Switzerland for longer than three months. Government subsidizes the premiums for the elderly, disabled, and low-income people. The insurance is secured in each Swiss canton from one of many competing health insurance companies that must operate on a not-for-profit basis so far as the compulsory policies are concerned. The insurance companies make their profits from other lines of insurance including supplementary health policies for services not covered by the government mandated basic benefit package. The compulsory basic benefit package includes GP and specialist services, hospital and nursing home care, home care, as well as a variety of preventive and other services. Most doctors in Switzerland practice individually in the community, and are paid by the patient's insurance company on a fee-for-service basis. The patient makes a co-payment directly to the doctor. The exact amount paid by the insurance company will depend on the specific services provided and will vary from canton to canton. The fee schedules within each canton are negotiated between the providers and the insurance companies, and approved by the cantonal government. It has been estimated that the compulsory insurance payment represents about 2/3 of the doctor's fee, the remainder paid either by supplementary insurance or out-of-pocket. All Swiss are assured that they can visit any GP, specialist, or hospital polyclinic within their canton. Hospital based doctors are paid mostly by salary. If a patient has supplementary health insurance, however, an extra charge may be made by the doctor for care in the hospital which is shared by the doctor and the hospital. The cantons, local governments, and other not-for-profit organizations operate hospitals. Hospitals are reimbursed for care by the insurance companies on a per diem basis, an amount which is negotiated within each canton between the insurance companies and the hospitals. These per diem payments cover operating costs. Construction and capital equipment costs are financed separately. Hospitals typically receive subsidies from the canton or municipal government to cover costs not covered by insurance and patient co-payments as well subsidies for capital costs. Private hospitals do not receive any subsidies but must earn their budgets from insurance and patient payments. University hospitals and some other large hospitals provide some of the more advanced services.