Swiss & Dutch Health Care Lessons for U.S.
The United States May Learn from Switzerland and Netherlands
Jan 22, 2009
While the United States is evaluating the structure of the health care system they may be able to learn something from the health care systems in other countries. A new study by Commonwealth Fund shows that the countries Switzerland and the Netherlands achieve near universal health coverage with low administrative costs.
Comparison of U.S. to Dutch and Swiss Systems
According to a study by the Commonwealth Fund, 15 percent of the people in the United States are uninsured. As people lose employment and companies cut back on benefits, that number will probably increase. People who cannot get coverage from places of employment have to purchase their own insurance coverage or do without health insurance
The health systems of the Netherlands and Switzerland cover all but one percent of their population. The Dutch and Swiss health systems spend about five percent of their heath budget on administrative costs.
In the United States the heath systems spend about seven percent on administrative costs. The rates are even high on private insurance policies in the U.S.
The Swiss and Dutch systems cover all but one percent of their population due to an individual mandate to purchase health insurance and premium assistance for people with low incomes. Both countries have successfully curbed high administrative costs
"These countries can serve as idea labs for health reform in the U.S., and we should seek to learn from their successes and failures, just as we learn from the experiences of states like Massachusetts," says Commonwealth Fund President Karen Davis. "There are examples of universal, comprehensive, high-quality, efficient health care systems that can show us the path to high performance."
Both the Netherlands and Switzerland have mixed public-private systems. Their individual mandate and insurance market reforms are similar to the Massachusetts universal coverage law. The Dutch and Swiss systems offer patient choice, broad access to health care and low rates of disparities in care according to study of the Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets, by Robert E. Leu of the University of Bern, Switzerland and colleagues.
Key Policies of Dutch and Swiss Systems
According to the Commonwealth Study there are key policies in the Dutch and Swiss systems that the U.S. might learn from:
- Universal coverage is attained by a mandate that every individual purchase a basic insurance plan. Both The Dutch and Swiss systems subsidize premiums for low-income households. About 40 percent of the households received insurance premium assistance.
- There are national standards for basic coverage through private insurance that insures that benefits are comprehensive for acute care services.
- The basic insurance markets are tightly regulated, with requirements for open enrollment and community rating. The tight regulation leads to relatively low overhead costs.
- Risk equalization systems help to reduce incentives for employers to seek healthier employee that end up enrolled in their insurance plans.
Results
The U.S. spends more per on health care when compared to the other two countries, according to figures from 2006. The U.S. spent 15 percent of the GDP and $6,700 per capita. Switzerland spent 11 percent of the GDP and $4,300 per capita. The Netherlands spent 9 percent of GDP and $2,800 per capita.
According the data, both Switzerland and the Netherlands have better health outcomes when compared to the United States. In 2005 the life expectancy in the U.S was 77.8 years. The life expectancy in the Netherlands was 79.1 years. The life expectancy in Switzerland was 81.4 years.
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
Resources
Commonwealth Fund Article
Swiss and Dutch Health Systems provide lessons for US on achieving universal coverage. EurekAlert.
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