Reinhardt_SwissHealthSystem

Reinhardt_SwissHealt - COMMENTARY The Swiss Health System Regulated Competition Without Managed Care Uwe E Reinhardt PhD H EALTH SERVICES

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COMMENTARY The Swiss Health System Regulated Competition Without Managed Care Uwe E. Reinhardt, PhD H EALTH SERVICES RESEARCHERS AROUND THE GLOBE have known for decades that the United States, with a comparatively young population, spends much more on health care than do other na- tions 1,2 ( TABLE ). As US annual health spending continues to exceed that in comparable nations by ever wider mar- gins, and as US health policymakers begin to run out of ideas for how to constrain that growth, interest in the perfor- mance of health systems abroad has increased in recent years. One need not import another country’s political system or social ethic to learn from the techniques they use to seek cost-effective health care. Cost-effective health care deliv- ers the maximum attainable benefit for a given sacrifice of resources or, alternatively viewed, minimizes the sacrifice in resources for a given level of benefits. While economic circumstance and a preferred social ethic may lead some na- tions to spend more on health care to achieve higher levels of benefits than others, in principle, all nations should strive for cost-effective health care at whatever level of health spend- ing they have chosen. Americans who are not in favor of government-run health insurance may find the German, Dutch, and Swiss health systems of special interest. None of these nations relies on government-run health insurance as in the model of the Ca- nadian provincial health insurance plans or the US Medi- care and Medicaid/State Children’s Health Insurance Pro- gram programs. All 3 have flirted in recent years with elements of price-based consumer choice, albeit within a framework of strictly regulated competition. The Swiss, for example, have experimented with con- sumer choice in the market for health insurance. In their article in this issue of JAMA , Herzlinger and Parsa-Parsi 3 ex- amine that system in detail and conclude that it delivers a superior, more cost-effective, and more equitable perfor- mance than does the US system. They believe that “the posi- tive results achieved by the Swiss system may be attributed to its consumer control, price transparency of the insur- ance plans, risk adjustment of insurers, and solidarity.” It is difficult to argue with the assertion by Herzlinger and Parsa-Parsi that, relative to the US health system, the Swiss system delivers an overall superior performance. Much the same can be claimed by many other foreign health systems because, in cross-national comparisons, the higher US health spending has not translated into consistently superior qual- ity of care 4 or in greater satisfaction among patients, 5 phy- sicians, 6 and hospital executives. 7
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This note was uploaded on 02/25/2012 for the course 360 290 taught by Professor Dankelemen during the Spring '11 term at Rutgers.

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Reinhardt_SwissHealt - COMMENTARY The Swiss Health System Regulated Competition Without Managed Care Uwe E Reinhardt PhD H EALTH SERVICES

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