5 clinical autonomy the clinical autonomy of

Info icon This preview shows pages 13–15. Sign up to view the full content.

5. Clinical autonomy: The clinical autonomy of independent Swiss clinicians ( libre practiciens ) is subject to increasing regulation. For example, there is a condition that insurers will only reimburse providers if services are clinically effective, appropriate and cost-effective. Measures to promote quality assurance, vary greatly between cantons. Providers have freedom to set up practice. 6. Conflicts of interest with the third party payer: A major weakness of the Swiss system is that the sickness funds have to contract with all hospitals, which prevents them from selecting approved lists of cost-effective or safe, or consumer-friendly doctors or hospitals. As in Germany, this is likely to change, with a shift in the near future towards greater freedom to contract. In addition, a variety of managed care schemes have been introduced over the last decade. In return for lower premiums, the nature of the relationship between third party payer and provider is altered in such schemes. Those choosing to leave managed care schemes often cite lack of choice as their main reason. 7. Responsiveness: One of the three pillars of the recent health insurance law was access to high quality treatment. The Federal government considers this has been achieved. Treatment capacity is high, partly because the cantons invest in hospitals. The number of physicians is growing. The Swiss system appears to be able to meet patient expectations and to adapt to changes in expectations more quickly than other health systems. 8. Fiscal viability: The Swiss system is very expensive and since 1996, has experienced steep increases in premiums. Taxation and match-funding also play an important role in health care, and there is concern that a number of perverse financial incentives serve to exacerbate spiralling expenditure. Pharmaceutical expenditure is very high (owing to domestic industrial policy which prohibits parallel imports), and there is a continual debate about how best to encourage more competition on the supply side. 6. Voluntary insurance, with tax subsidies, paid by employers (USA). The health sector in the United States is diverse and is characterised by a mix of public (45 per cent) and private (55 per cent) funding. Seventy two percent, or 200 million people, have private insurance. Of those, 177 million received their coverage through the workplace. 1. Price consciousness: Employers usually pay for most of an employee’s health insurance, so apart from their co-payments and deductibles, individuals have little incentive to economise. In recent years employers have become concerned about the high cost of health benefits and tried to reduce expenditure by introducing managed care. A number of recent innovations (e.g. Defined Contributions Plans and Medical Savings Accounts), aim to engage consumers in the decision- making process about their health coverage, and to provide incentives for them to use services wisely.
Image of page 13

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

14 12 Reducing The Costs Of Poor-Quality health Care Through Responsible Purchasing Leadership , Midwest
Image of page 14
Image of page 15
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '18
  • Universal health care

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern