Coverage for Medications In the U.S., the price of medications and the amount covered by the insurance company depends on the health insurance plan purchased which sometimes leaves individuals with high out-of-pocket cost for medications, or they may chose to not follow the prescribed treatment regimen unless another covered alternative exists. In Switzerland, most medications are covered under the basic health insurance as long as they are prescribed by a doctor and on an official list. Citizens may choose to purchase supplemental health insurance to help cover some non-covered charges under the basic health insurance or have the freedom of doctor choice in the hospital. Branded medicine 4
Task 3: Healthcare Financing cost as much as 20 percent deductible compared to generic medicine that only require 10 percent deductible (Healthcare in Switzerland, 2017). Specialist Referral In Switzerland, the mandatory health insurance covers most specialist services; therefore an individual may go see a specialist without a referral (The Swiss Health Care System. (n.d.)). In the U.S. most insurance companies require a referral to see any specialist because they need documentation of medical necessity in order to pay for the services offered. Coverage for preexisting conditions With the passing of the Affordable Care Act in the U.S., as of January 1, 2014, “health insurance companies can’t refuse to cover you or charge you more just because you have a preexisting condition. They cannot limit benefits for that condition either” (Pre-Existing Conditions, 2017). In Switzerland, the universal healthcare law prohibits insurance companies to deny coverage based on previous health conditions. Financial Implications The universal healthcare system of Switzerland is a great advantage for the residents of the country Even though it costs approximately $5,350 per year per resident, the government regulates the healthcare system, costs of drugs and fees for medical tests and treatments and there is a limit in the deductible paid by each individual. The universal healthcare system also “reduces the need, and therefore the cost, for emergency room visits for non-urgent complaints” (Bachmann, 2012). 5
Task 3: Healthcare Financing The health insurance premiums are also regulated and cannot exceed 8% of personal income and do not vary by age in Switzerland as they do in U.S. The Swiss government also has mandated individual private health insurance policies rather than employer sponsored health plans like in the U.S., which is great advantage for individuals to not have issues with the lack of health insurance coverage, therefore face financial burden when transitioning between jobs. All of these factors contribute to the high ranking of Switzerland as the second-highest life expectancy in the world and among the healthiest in the world (Bachmann, 2012).
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