Sunday, October 4, 2009

Swiss Hit -- Or Miss?

As more American realize that they don't want to duplicate either the Canadian or British health care systems, proponents of "universal health care" have been casting about for other less well-known countries to propose as models.

The latest model being pitched as a "hit" is Switzerland. For example, the September 30, 2009 New York Times featured a piece by Nelson Schwartz entitled "Swiss Health Care Thrives Without Public Option".

In particular Schwartz claims:
The Swiss government does not "ration care" -- that populist bogeyman in the American debate -- but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs -- at a higher level than in the United States -- so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
But what does that really mean?

Fortunately, Linda Gorman of the Independence Institute has looked more closely into the Swiss system and noted the following:
...[W]hen the Swiss replaced mixed government and private financing of health care with mandatory health insurance in 1994, the resultant cost cutting efforts both damaged quality and introduced a lot of waste into the Swiss system.

In 2002, the government banned all new medical practices to control costs. The ban runs until 2010. Until then, a new physician cannot open a practice unless an old physician retires or dies. Efforts to save money by merging hospitals have created irrational allocations of specialty units. Alphonse Crespo, a Swiss orthopedic surgeon, reports that resources are now so poorly distributed that "because of the mergers, the distances between specialty units in some cantons are large." Patients needing a urologist may have to go to another hospital. Patients have actually been put in helicopters just for a consultation. Researchers at the University of Lausanne report difficulties in accessing psychiatric care, rehabilitation care, long-term care, and orthopedic care. Rationing is more likely to be imposed on the elderly and those with "a poor level of social integration."

...Between 1971 and 2005, the average inflation-adjusted general practitioner salary in Switzerland fell by 37 percent before taxes. More young doctors are choosing to become specialists because the pay is better and the work is more interesting. There is a developing shortage of primary care. In March, reported that general practitioners held the first doctors' strike "in living memory." The government had decided to further ration practitioner access to laboratory tests.

With mandatory health insurance premiums set to rise 15 percent this year, the Swiss government is proposing more cuts. The cuts include restrictions on the type of health insurance that can be offered, restrictions on outpatient services, and a "patient tax" that would require people to pay for their first six visits to a doctor’s office.

...Even with the cuts, in some cantons, the mandatory premium increase may be as much as 20 percent.
(To see her references and hyperlinks, go to the full text of her post "Taking Another Look at Swiss Health Care".)

Restricting new medical practices? Raising prices to limit access? Limiting the availability of lab tests?

Sounds an awful lot like rationing to me.

Rather than being a hit, their system is a giant Swiss Miss...