Jacqueline Wilson

Author: Jennifer Fulton

Here at the Nanovic Institute, we've just started going through the materials sent to us by our fall break grant recipients. What exciting and educational trips they have taken! One of those fall break grant recipients is Jacqueline Wilson. Inspired by current healthcare debates in the US, she traveled to Switzerland to research their consumer-driven healthcare system. When she returned, she sent us a report of her experience:

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As healthcare reform continues to be a topic of debate in the United States, we should look to the successful healthcare systems throughout the world for options, alternatives, and answers to our healthcare challenges. One such system is the Swiss consumer-driven healthcare system, which consistently achieves universal coverage, widespread access, lower costs, and excellent quality.Over fall break, I completed research and met with residents throughout Switzerland, with the objective of studying Swiss healthcare and the roles that transparency, culture, and inequality play within this system. Through my interesting research and eventful travels, I learned a great deal about Swiss healthcare and culture. This journey shaped the way I see healthcare, its future in the United States, and the role I hope to one day play in it.

After studying US healthcare policy in Washington DC, I was intrigued by the “consumer-driven” and “market-based” policies that some politicians advocated for (or wanted more of) within the Affordable Care Act. In order to examine a more consumer-driven and market oriented system, I looked to Switzerland. Harvard Business School professor and healthcare expert, Regina Herzlinger, defines consumer-driven healthcare as a system that “combines free demand and supply, transparency, and active government over-sight”. Although the Swiss system is not perfectly consumer driven, as it does place constraints on demand and supply, it is a great example of what market influences can do to control costs, increase efficiency, and improve quality.

By examining the Swiss Federal Law on Healthcare Insurance (LaMal for short), I was able learn a great deal about the Swiss healthcare and insurance systems. In Switzerland, all residents are required to have health insurance. Unlike the US healthcare system, all individuals buy their own insurance from a private insurer, rather than their employer or the government (Medicare, Medicaid) providing the insurance. Insurers must have policies that meet a required set of minimum benefits, and they cannot deny participants for age or pre-existing conditions. If basic plan insurance premiums exceed 8% of personal income, the Swiss government will provide a subsidy. Plans vary by the price of the premium, deductible, and copayment. Besides the basic, compulsory insurance that all residents must buy, they also have the option to buy supplementary insurance that covers more services. This system has led to some of the best healthcare outcomes in the world. They achieve this while keeping healthcare costs much lower than those in the US, 11.0% GDP compared to 17.7% GDP (2011). Overall, Swiss healthcare is characterized by using the private market, encouraging individual responsibility, supporting those in need, and obtaining excellent outcomes.

In order to truly understand the benefits and drawbacks of this system, I had to directly speak to consumers, especially with regards to the roles of transparency, culture, and inequality. As an IT management major, I was especially interested in the online resources consumers have to compare prices, insurers, and providers. After speaking with residents, I learned that there are excellent websites for consumers to compare insurance options (http://en.comparis.ch/, http://www.priminfo.ch/praemien/index.php?sprache=d). However, similar to the US, there are few resources for them to decide what provider (doctor, hospital etc.) has the best outcomes and prices. In order for the Swiss system to be truly consumer-driven, it needs to improve transparency measures and resources for both insurers and providers.

Culture is a very important component to healthcare, so traveling throughout Switzerland and meeting with residents was essential to understanding the different influences within the Swiss system. The consumer-driven healthcare system reflects the independent yet supportive nature of Swiss culture. While speaking with a resident on the plane, she described that Swiss culture places a great deal of emphasis on individual responsibility but still recognizes the importance of social securities and safety nets. This reflects the mandate that residents must buy their own insurance but can also receive subsidies and assistance from the government.

Because health inequality is such an important topic in the United States, I had hoped that Switzerland could provide some insights into dealing with this important social justice topic. As long as healthcare systems allow participants to buy supplementary insurance beyond the minimum, there will be inequalities between those that can afford beyond the compulsory plan and those that cannot. However, because Switzerland has an expansive minimum benefits package, a low rate of poverty, and a good subsidy system, they have not had as many problems with healthcare inequality as the United States. This is also due to excellent quality of public services in Switzerland, in which variables that affect health such as education, housing, and food are much more robust, equal, and efficient.

Through my travels in Switzerland, I also hoped to analyze the applicability of the Swiss healthcare system in the United States. With the new reforms in the US, Americans without insurance can now buy insurance on exchanges that are very similar to the Swiss healthcare experience. But could this system be applied across all US residents? Because of our similar focus on individualism and individual responsibility, it is culturally feasible. However, many people would not support the inconvenience of losing their current Medicaid, Medicare, or employer based insurance in exchange for a plan they select themselves. Due to our large size and polarized views, I hypothesize that the US will continue to have a “glued-together” system that represents many different types of healthcare systems from across the globe. My experience in Switzerland was absolutely incredible. I thoroughly enjoyed my time there and met with many great people, from Notre Dame Alumni to Swiss citizens. This trip further solidified my passion for healthcare, specifically when it comes to policy and the implementation of policy. I am thrilled to be able to share these new insights with other Notre Dame students whom I will be leading on the healthcare policy seminar in Washington D.C. next spring. I will forever be grateful for the Nanovic Institute’s generosity and support.