For the ensuing articulated discourse regarding the comparison between healthcare systems, the selected subject countries are the US and Switzerland.
Access by Children, Unemployed and the Retired Comparison
In the US, approximately forty-five million individuals under the age of sixty-five lack insurance cover (Ham, 2005). Nonetheless, for the unemployed individuals in the US system, they can access an affordable health insurance plan through the Marketplace based on savings, household size, and income. Also, since the household size and income rather than employment status determine the type of health coverage, the unemployed can as well qualify for the low-cost or free coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Moreover, based on the provisions of the ACA, dependent children in the US access healthcare through their parents’ employer-sponsored insurance until they attain 26 years. Also, foster youths, as well as children from families earning 133% below the federal poverty level, are assured of access to Medicaid through CHIP, (Spencer et al., 2018). Individuals that retire before the age of 65 and lose their job-based health plans can purchase new plans from the Health Insurance Marketplace within a special enrollment period outside the regular open enrollment period. For retirees past the age of 65, they can access healthcare services through the retiree coverage that has premium tax credits and minimal out-of-pocket costs.
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Comparatively, the Swiss healthcare system is universal whereby all individuals regardless of age, gender, race, or employment status receive access to all advanced medical services. In this healthcare system, there are no free state-sponsored health services and private health insurance is mandatory for all persons residing in the country within three months of either taking up citizenship or birth.
Coverage for Medications
Indeed, the private healthcare sector is the dominant healthcare system in the US, and as such, it provides differential formularies that specify low-cost drugs based on the tier of insurance cover or health plan. However, for unspecified medications in a formulary, the patients are required to pay a higher percentage of the medication cost. However, most formularies cover at least a single drug in each drug class and allow for generic substitution, (Scott, 2016). In contrast, Switzerland specifies only two types of medications, prescription and over the counter. Basic health insurance plans and policies cover prescription medication. However, the patient still needs to pay ten percent of the total cost either immediately or through an invoice forwarded by the insurance company. Moreover, even though doctors and pharmacies do not accept foreign prescriptions, almost every pharmacy keeps a record or file for each patient’s history of medications and prescriptions. Ultimately, over the counter medications are fully covered by the patient.
Requirements for Referral
Regarding conditions for a referral to see a specialist, the US healthcare system posits that there must be a written order from the patient’s primary care physician. However, in some Health Maintenance Organizations, one needs to get a referral prior before accessing medical services from any specialist except their primary care physician. Thus, without a referral, the plan may not cover the services. In the Swiss healthcare system, on the other hand, one needs to proffer a health insurance card or proof of private health coverage during an appointment through which the doctor legitimizes referral to a specialist, (Tandjung et al., 2017).
Coverage for a Preexisting Condition
Based on the requirements of the ACA, once an individual has insurance coverage in the US, treatment for a preexisting condition is assured through the cover. Further, insurers are prohibited from charging more or withhold coverage to a child based on a preexisting health condition such as diabetes, cancer, etc. Also, neither can the insurer limit benefits to the child or adult for that condition. Similarly, based on the universal coverage policy of the Swiss healthcare system, no insurer is allowed to refuse coverage to an applicant or insured individual regardless of factors such as chronic or preexisting conditions. However, when taking out an additional insurance cover, insurers reserve autonomy unlike in basic health insurance coverage to reject an individual’s application if they have a preexisting condition.
Financial Implications for High Healthcare Costs
Even though both systems evidence high quality and excellent healthcare delivery, the healthcare services provided are expensive and costly to the public with some aspects of the expenses not having direct benefits to the public (Scott, 2016). Thus, two of the significant financial impacts are reduced disposable income and savings as well as reduced employer-based coverage or increased cost-sharing.
Reduced Disposable Income and Savings
Elaborately, according to Swissinfo (2017), health insurance premiums have doubled while salaries have only risen by 22 percent in the space of sixteen years (between 1999 and 2015). Similar trends have been observed in the US whereby premiums are increasing more than twice the growth rate of other financial indicators such as wages and consumer price inflation, (Collins, 2008). In effect, this inverse relationship between income and insurance premiums sees more expenditure directed towards health services thereby reducing the patients’ purchasing power due to low income and savings.
Reduced Employer-Based Coverage/Increased Cost-Sharing
On the other hand, reduced employer-based coverage refers to the unwillingness of employers to cover their employees due to increased cost as a means of lowering organizations’ overhead expenses. This strongly correlates to cost-sharing in terms of deductibles by both employers and insurers. According to (Collins, 2008), the 2006 statistics indicate that there was a surge in health expenditures by seven percent annually –which was more than twice the economic growth rate in the US with similar projections in 2017. Comparatively, despite healthcare coverage in Switzerland being compulsory and undertaken by sixty different insurance companies, insurers generally admit the reduction of reserves below the minimum requirement. Thus, while employers, especially in the US, increasingly opt out of providing employee coverage, insurers in Switzerland tend to increase the cost-sharing ratio towards evenness to cover the costs. Consequently, out-of-pocket expenditure increases for patients in both countries.
References
Collins, S. R. (2008). Testimony-rising health care costs: implications for the health and financial security of U.S. families. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/publication/2008/oct/testimony-rising-health-care-costs-implications-health-and
Ham, C. (2005). Money can't buy you satisfaction. Bmj , 330 (7491), 597-599. Doi: 10.1136/bmj.330.7491.597
Scott, D. M. (2016). The United States Health Care System: A Pharmacy Perspective. The Canadian Journal of Hospital Pharmacy , 69 (4), 306. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008427/pdf/cjhp-69-306.pdf
Spencer, D. L., McManus, M., Call, K. T., Turner, J., Harwood, C., White, P., & Alarcon, G. (2018). Health care coverage and access among children, adolescents, and young adults, 2010–2016: Implications for future health reforms. Journal of Adolescent Health , 62 (6), 667-673. Doi:10.1016/j.jadohealth.2017.12.012
Swissinfo. (2017). Health insurance costs keep on rising. Retrieved from https://www.swissinfo.ch/eng/expensive-coverage_health-insurance-costs-keep-on-rising/43553132
Tandjung, R., Morell, S., Hanhart, A., Haefeli, A., Valeri, F., Rosemann, T., & Senn, O. (2017). Referral determinants in Swiss primary care with a special focus on managed care. PloS one , 12 (11), e0186307. https://doi.org/10.1371/journal.pone.0186307
