Improving Quality Is Necessary to Reducing Health Care Cost
Part of the Executive Summary from a report entitled "Opportunities for Value-Based Competition in Swiss Health Care" by Elizabeth Olmstead Teisburg PhD, Darden Graduate School of Business, University of Virginia, August 2007
Switzerland’s health care system has served the country well, yet is facing rapidly increasing
pressure from rising costs, an increasing incidence of chronic disease, and an
aging population. Federal regulation requires that all residents have health insurance
coverage and access to health care of high quality, with services that are effective, appropriate,
and effi cient. Given the pressures, reform discussion tends to focus on costs.
The paradox, however, is that the more that health care reform focuses on restraining
costs, the more those costs will spiral out of control.
The opportunity of health care reform is that good health costs less than illness. Poor
coordination, waste, errors, and practices inconsistent with medical evidence result in
worse health outcomes at higher costs. Reforms that reorganize care on the level of improving
VALUE FOR PATIENTS make it possible to achieve a system that effi ciently and effectively
provides high quality care for all.
And. . .
In press - Draft published online August 23, 2010 (http://www.sciencedirect.com/science/article/pii/S0091743512003787)
High prevalence of forgoing healthcare for economic reasons in Switzerland: A population-based study in a region with universal health insurance coverage
By I. Guessous, J.M. Gaspoz, J.M. Theler, H. Wolff
Health insurance is compulsory for all citizens in Switzerland and insurance premiums are paid independently of income. Health insurance covers the costs of medical treatment and hospitalization for the insured. The insured person pays part of the cost of treatment: an annual flat deductible, called the franchise, chosen by the insured person (with premiums adjusted accordingly) and a 10% co-pay of the costs up to a stop-loss annual amount of CHF 700 (1CHF≈1$). Between 1099 and 2010, health insurance premiums increased by 77%, coupled with increasing out-of-pocket payments. Increasing out-of-pocket spending may, at least in some settings, reduce the use of clinically important services and drugs to prevent the onset and progression of chronic disease (Paez et al., 2009).
We aimed to determine the characteristics of participants who report forging healthcare and to describe the past 4-year trend for forgoing healthcare for economic reasons.
To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland.
Population-based survey (2007–2010) of a representative sample aged 35–74 years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.
A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income ≥ 13,000CHF (1CHF ≈ 1$) to 30.9% in the group with a monthly income
In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.
► Forgoing healthcare for economic reasons is frequent in a region of Switzerland.
► This prevalence varies with reported monthly household income category from 3.7% to 30.9%.
► Data suggest an increasing 2007–2010 trend among participants with the lowest income.
► Risk factors include gender, smoking, occupation, children, being divorced, and insurance status.
► Forgoing healthcare is associated with worse self-rated health status.
Dr. Don McCanne's comment:
Conservatives in the United States often praise the Swiss health care financing system largely because it is composed of a choice of private health plans (although they may not like the facts that it is compulsory, that it is heavily regulated, and that it is one of the most expensive financing systems in the world). So what is the policy lesson from this study of the Swiss system?
The out-of-pocket deductibles and coinsurance result in a high prevalence of forgoing health care for economic reasons. The prevalence is inversely related to household income, but even at the highest income levels, some do forgo health care for economic reasons. Forgoing health care is associated with worse self-rated health status, and reduces the use of clinically important services and drugs.
Other nations have shown that you do not have to have deductibles, co-payments, and coinsurance to control health care spending. Since these cost sharing measures do have the detrimental effect of reducing the use of clinically important services and drugs, they should be rejected as bad policy. The other measures inherent in a well designed single payer system obviate the necessity of patient cost sharing.
You can not pass a law and mandate that health care be paid by the taxpayer and be of high quality. Rather, you must actually work to make health care be of high quality. If you do, then your costs will decrease and your nation will be able to afford health care for all citizens. ObamaCare is an attempt to buy our way into better health care. This is not possible. There is not enough money in any nation to simply buy the way to health system reform. We must, at some point, come to recognize that real health system reform will be difficult, principally because real reform requires that we recognize which providers of health care goods and services are not necessary and then begin to tell them "NO". That is politically difficult. The alternative strategy, which is to simply pass on more and more costs to 'consumers', does not actually reduce overall costs. In fact, that strategy raises costs because it does not reduce use of ineffective treatments while allowing selected patients to become sicker and therefore more expensive to treat.
Who is ready to do the hard work necessary to IMPROVE VALUE FOR PATIENTS?
Dr. Joe Jarvis