Abstract
This paper applies the five standard criteria for assessing the performance of an economy to one of its sectors, namely, the provision of health care. They are (1) matching of consumer preferences, (2) technical efficiency, (3) adaptive capacity, (4) dynamic efficiency, and (5) a distribution of income that provides incentives for producers to attain criteria (1) through (4).
Being insurance-based, the Swiss healthcare system comprises three contractual relationships that can be judged in the light of these criteria.
First, the relationship between consumers and health insurers satisfies criterion (1) to a high degree, not least thanks to the managed-care (MC) options that were introduced with the new law on health insurance (effective 1996). However, it fails with regard to (2) because cost reductions achieved by MC cannot be passed on to consumers but to a very limited degree. The relationship between health insurers and service providers, by way of contrast, does not fully satisfy any of the five criteria, mainly because health insurers continue to operate under an any-willing-provider clause for conventional fee-for-service care. This makes it difficult for them to find MC providers. Finally, the relationship between consumers and healthcare providers match consumer preferences well (criterion 1) but do not result in an income distribution in the healthcare sector that is conducive to the attainment of criteria (2) through (4).
The total score for the Swiss healthcare system amounts to 13 points out of a maximum of 30, to which the relationship between insurers and providers contributes only 3 points. Therefore, performance could be improved by granting health insurers freedom to contract not only with domestic but also foreign healthcare providers offering a favorable benefit cost ratio.
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References
OECD Health Data, Paris 2004
Hirshleifer J, Hirshleifer D. Price theory and applications, 6th ed. London, UK: Prentice-Hall, 1998
Laffont J-J, Tirole J. Theory of incentives in procurement and regulation. Cambridge (MA): MIT Press, 1993
Federal Office of Health (Bundesamt für Gesundheit, BAG). Statistik der obligatorischen Krankenversicherung (Statistics of mandatory health insurance) [several issues]. Bern: EDMZ, 2005
Schut FT, Van de Ven WPMM. Rationing and competition in the Dutch health-care system. Health Econ 2005; 14(51): 59–74
Wörz M, Busse R. Analysing the impact of health-care system change in the EU member states: Germany. Health Econ 2005; 14(51): 133–68
Lehmann H. Managed care. Kosten sparen mit alternativen Versicherungsformen? [Managed care: cost savings through alternative health insurance settings?). Zurich: Rüegger, 2003
Lehmann H, Zweifel P. Choice of managed care and cost savings: the role of latent health status. In: Chiappori P-A and Gollier C, editors. Competitive Failures in Insurance Markets: theory and policy implications Cambridge (MA): MIT Press, 2006
Lehmann H, Zweifel P. Innovation and risk selection in deregulated social health insurance. J Health Econ 2004; 23(4): 997–1012
Laske-Aldershof T, Schut E, Beck K, et al. Consumer mobility in social health insurance markets: a five-country comparison. Appl Health Econ Health Policy 2004; 3(4): 229–41
Zweifel P, Breyer F. Health economics. New York (NY): Oxford University Press, 1997
Oliver A, Mossialos E, Wilsford D, editors. Legacies and latitude in European health policy. J Health Politics Pol Law 2005; (1–2): 1–314
Oliver A, Mossialos E, Maynard A. The contestable nature of health policy analysis. Health Econ 2005; 14(51): 3–36
Winkelmann R. Work and health in Switzerland: immigrants and natives [working paper]. Zurich: University of Zurich, 2002
van Doorslaer E, Koolman X, Puffer F. Equity in the use of physicians in the OECD countries: has equal treatment for equal need been achieved? In: Measuring up: health systems performance in OECD countries. Paris: OECD, 2002: 225–48
Leu RE, Schellhorn M. Intermediate report to the Swiss National Science Foundation on the impact of the new law on health insurance on the insured. Bern: University of Bern, 2004
WHO. World health report. Geneva: World Health Organization, 2000
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Zweifel, P. Building a Competitive Insurance System. PharmacoEconomics 24 (Suppl 2), 111–119 (2006). https://doi.org/10.2165/00019053-200624002-00012
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DOI: https://doi.org/10.2165/00019053-200624002-00012