<<  <  >  >>

Figure 3

Percentage of Total Health Spending Paid by Government

United Kingdom

Norway

Japan

France

Germany

Italy

Portugal

Spain

Canada

United States

Greece

Switzerland

0

10

20

30

40

50

60

70

80

90

100

Source: OECD, "OECD Health Data 2007: Statistics and Indicators for 30 Countries." Organisation for Economic

Co-operation and Development, July 2007; 2004 data.

Note: Switzerland excludes mandatory insurance premiums.

insurance. Thus, with high deductibles and

than smokers. A formula adjusts premiums

based on sex and age.259 The geographic varia-

extensive copayments, the Swiss pay out of

pocket for 31.5 percent of health care, twice as

tion can be significant, with premiums differ-

ing as much as 50 percent between cantons.260

much as in the United States.262 (See Figure 4.)

Recently, there has also been a growing

Unable to compete on the basis of manag-

market in managed care plans that, like those

ing and pricing risk, and required to offer

in the United States, offer lower premiums in

nearly identical basic benefits packages,

exchange for limitations on access to special-

insurers compete primarily on price. Since

ists and other services. Premiums for such

they cannot reduce costs by risk manage-

plans run around $1,900 per year.263

ment or benefit design, they generally man-

age prices by varying the level of deductibles

The Swiss government offers subsidies to

and copayments. Individuals can purchase

low-income citizens to help them purchase a

Insurance is

expensive policies with very low deductibles

policy. Subsidies are based on both income

and copayments, or far less expensive policies

and assets, and the maximum available sub-

generally

with high deductibles or extensive copay-

sidy covers the cost of an average premium in

purchased on an

ments. Thus, premiums vary according to

the individual's canton. These subsidies are

their cost-sharing attributes and plan type,

designed to prevent any individual from hav-

individual basis.

running from $1,428 per year for a plan with

ing to pay more than 10 percent of income

Few employers

a deductible of approximately $2,000 to

on insurance. They do not, however, pay the

contribute to

$2,388 for a plan with a $250 deductible.261

entire cost of insurance because the Swiss do

not want to create an incentive for subsidized

Because employers do not pay for workers'

the purchase

individuals to choose the most expensive

health insurance, the Swiss are exposed to the

or provide

plan with the lowest deductibles and copay-

full cost of their insurance purchases. As a result,

ments.264 Roughly one-third of Swiss citizens

insurance.

many Swiss have opted for high-deductible

26