According to the researchers, both countries effectively cover all but one percent of their population - compared with 15 percent uninsured in the U.S. - due to an individual mandate to purchase health insurance and premium assistance for those with low incomes. Both countries, the authors write, have also been successful at curbing high administrative costs: the Swiss and Dutch health systems spend about five percent of health care costs on administrative costs, compared with an average of seven percent and even higher rates in private insurance policies in the U.S.
The study highlights: both Switzerland and the Netherlands have mixed public-private systems with an individual mandate and insurance market reforms that are similar to the Massachusetts universal coverage law. Both countries' health systems also feature patient choice, broad access to care, and low rates of disparities in care.
Key policies that the U.S. might learn from include:
- Universal coverage attained through a mandate that every individual purchase a basic insurance plan. Both Switzerland and the Netherlands subsidise premiums for low-income households, with about 40 percent of households receiving premium assistance in both countries.
- National standards for basic coverage for private insurance ensure that benefits are comprehensive for acute care services.
- Tight regulation of basic health insurance markets, with requirements for open enrolment and community rating, lead to relatively low overhead costs. Administrative and profit-margins account for about 5 percent of premiums.
- Risk equalisation systems help to reduce incentives for insurers to seek healthier enrolees.
While the U.S. spent 15 percent of GDP and 6,700 U.S. dollars per capita on health care in 2006, Switzerland spent eleven percent and the Netherlands nine percent of GDP on health spending; per capita spending was 4,300 U.S. dollars in Switzerland and 2,800 U.S. dollars in the Netherlands. Both countries achieve better health outcomes compared to the U.S.: in 2005, life expectancy in the U.S. was 77.8 years, compared with 81.4 years in Switzerland and 79.1 years in the Netherlands.
MEDICA.de; Source: Commonwealth Fund