The New York Times - Health Care Abroad: Switzerland lyrics

Timothy Stoltzfus Jost is a law professor at Washington and Lee University and frequently writes on comparative health care policy. His work includes an examination of insurance coverage in Switzerland and a comparison of the Swiss and Dutch systems. He spoke to the freelance writer Anne Underwood. Q-Timothy Stoltzfus Jost A- Anne Underwood Q. The Swiss health care system relies on public-private approaches that have been recommended as models for the United States. What are the similarities? BY THE NUMBERS Switzerland • Life expectancy: 82 • Infant mortality: 4 per 1,000 live births • Health spending as a percentage of GDP: 11.3 • Percentage of health spending that is private: 40 • Doctors per 10,000 people: 40 Source: World Health Organization. U.S. statistics. A. In 1996, Switzerland instituted an individual mandate by which people are legally required to purchase health insurance in a competitive market. People buy coverage from private insurers, and the government provides subsidies for those who can't afford coverage. About a third of the population receives subsidies. Q. Is there an employer mandate, too? A. No, it's an individual mandate. Group health insurance does not exist in Switzerland. Q. What is your biggest criticism of the Swiss system? A. It hasn't done well at controlling costs. Switzerland is second only to the United States in the percent of G.D.P. spent on health care. It's also second to the United States in the rate of health care inflation. Probably the most important reason is that Switzerland is a wealthy nation, and wealthy nations spend more on medical care. But a particular problem is that the Swiss use more health care resources than even we do in the United States, with more doctors, hospitalizations and certain high-tech procedures. Q. What is the most important lesson Americans should learn from the Swiss system? A. You can achieve universal coverage through an individual mandate, coupled with subsidies for people who can't afford health insurance. But it's not going to get you cost control unless you enact further measures.