AHIA 2010 9 November 2010 Sydney PRIVATE HEALTH / PUBLIC GOOD How - - PowerPoint PPT Presentation

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AHIA 2010 9 November 2010 Sydney PRIVATE HEALTH / PUBLIC GOOD How - - PowerPoint PPT Presentation

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AHIA 2010 9 November 2010 Sydney PRIVATE HEALTH / PUBLIC GOOD How to Integrate Private and Public Actors in Health Care: the Swiss Answer Prof. Dr. Thomas Zeltner Advanced Leadership Initiative, Harvard University, USA Former Secretary of

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How to Integrate Private and Public Actors in Health Care: the Swiss Answer AHIA 2010

9 November 2010 Sydney

PRIVATE HEALTH / PUBLIC GOOD

  • Prof. Dr. Thomas Zeltner

Advanced Leadership Initiative, Harvard University, USA Former Secretary of Health and Director General of Swiss Federal Office of Public Health

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7.5 million

22.5 million

184/km2 2/km2

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Gross national income per capita

$ 41.830 $38.210

World Bank, International $, 2009

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National Ranking in Happiness

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Overall Views of Health Care System, 2010

Commonwealth Fund 2010 Internaltional Health Policy Survey

Percent AUS SWIZ UK US

Only minor changes needed

24 46 62 29

Fundamental changes needed

55 44 34 41

Rebuild completely

20 8 3 27

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Let‘s move to Switzerland...

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To do list

  • Register at the local resident registration
  • ffice
  • Tax computation
  • Sign up for an health insurance
  • (98 % are insured)
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Swiss Style Universal Coverage

  • Everyone buys their own health insurance
  • Everyone pays the same premium in a given

insurance plan and in a given region

  • Government enables lower income classes to

participate

  • Health insurance companies = Private, Non-Profit,

(84 companies, 5 share 80% of the market)

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The Swiss System after the 1996 Reform

  • Universal coverage with a standardized benefit package

through privately organized health insurances (Mandatory Basic Health Insurance)

  • Full mobility between health insurers: obligation to

accept all applicants and to charge the same premium to everyone regardless of age, gender or medical history

  • Government subsidies for people with low income (40%
  • f the population get subsidies)
  • Implementation of a risk equalization scheme
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Financing of Swiss Health System (2009)

Total: US$ 60 billion (7’500 per person) Sources: 1/3 basic Health Insurances 1/3 Taxes (Federal and Cantonal) 1/3 out of the Pocket ( + ev. complementary Private Health Insurance)

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Out-of-Pocket 21% Basic health insurance 42% Social security 3% Other social insurances 7% Other private 1% Voluntary complementary health insurance 10% Subsidies of hospitals etc. 16% Premium subsidies (federal, cantonal) 6% Premiums Social Health Insurance 30% Co-payment 6%

Financing of Swiss Health System (2009)

Total: US$ 60 billion

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What you get:

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Assets of the Swiss Health System

  • Universal health insurance coverage, access to a broad

benefit package without restriction

  • Health outcome indicators among the best worldwide

and continue to improve (exceptions: mental health, substance abuse)

  • Few health inequalities compared to other OECD

countries

  • High customers satisfaction, hardly any waiting time
  • Free choice of physician
  • No accumulated deficits
  • Health is one of the most important economic sectors
  • Excellent biomedical research
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<1/3 mile <3 miles

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Switzerland Health Data Comparison

per million population Switzerland Australia Physicians 3900 3800 Nurses 15200 13900 Acute Hospital Beds 3400 2500 MRI Units 14.2 ? CT Scanners 18.9 ?

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Wait Times for Specialist Appointments

Commonwealth Fund 2010 Internaltional Health Policy Survey

Percent AUS SWIZ UK US

Appointment: Less than 4 weeks

54 82 72 80

Appointment: 2 months or more

28 5 19 9

Elective Surgery: Less than 1 month

53 55 59 68

Elective Surgery: 4 month or more

18 7 21 7

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Cost-Related Access Problems in Past Year

Percent AUS SWIZ UK US

Did not fill prescription or skipped doses

12 4 2 21

Had a medical problem but did not visit MD

13 6 2 22

Skipped test, treatment or follow up

14 4 3 22

Yes to at one of the above

22 10 5 33

Commonwealth Fund 2010 Internaltional Health Policy Survey

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Challenges for Swiss Health System

  • Demographic challenges
  • Quality & Transparency
  • Shortage of adequate data
  • Spending on health 10.8% of GDP
  • Shortages / migration of health care

professionals

  • Predominance of health care in the health

system (Prevention represented 2.1% of the Swiss health expenditures)

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Leadership for Better Quality in Health Care

Applied Leadership Enterprise Performance Performance Improvement

People Systems

Applied Leadership: Best practices in high performance project impact. Enterprise Performance: Hospital systems performance of OR, ED, Radiology, Laboratory, Pharmacy, Administration and Nursing. Performance Improvement: Project focused integrated performance with sustained gains. People Systems: Talent recruitment development, retention, and rewards.

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Growth of Healthcare costs

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 1960 1970 1980 1990 2000 2010 2020

United States Switzerland

+ 2.0% / year + 2.5% / year

GDP

+ 3 million US$ per day

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Serious Problems Paying Medical Bills, by Income

Above-average income Below-average income

Commonwealth Fund 2010 Internaltional Health Policy Survey

10 20 30 40 AU SW UK US Above Below

20 13 15 11 4 5 29 31

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Problems with Health Insurance

Commonwealth Fund 2010 Internaltional Health Policy Survey

Percent AUS SWIZ UK US

Spent a lot of time on paperwork or disputes

  • ver medical bills

6 6 3 17

Health Insurance denied payment or did not pay as much as expected

11 10 2 25

Yes to either

14 13 5 31

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  • Health Professionals: too few, too unhappy….
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  • Health Professionals: too few, too unhappy….

Hope for change is here!

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Thank you for your attention!

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Problems with Health Insurance

Percentexperienced at least one of twoproblems Above-averageincome Below-averageincome

Commonwealth Fund 2010 Internaltional Health Policy Survey

10 20 30 40 AU SW UK US Above Below

20 13 15 11 4 5 29 31

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Serious Problems Paying Medical Bills, by Income

Above-average income Below-average income

Commonwealth Fund 2010 Internaltional Health Policy Survey

10 20 30 40 AU SW UK US Above Below

20 13 15 11 4 5 29 31

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Wait Times for Specialist Appointments

Commonwealth Fund 2010 Internaltional Health Policy Survey

Percent AUS SWIZ UK US

Appointment: Less than 4 weeks

54 82 72 80

Appointment: 2 months or more

28 5 19 9

Elective Surgery: Less than 1 month

53 55 59 68

Elective Surgery: 4 month or more

18 7 21 7

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National Ranking in Happiness

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Characteristics of the Swiss health system

  • National & 26 cantonal governments share competences in

health policy

  • Predominance of health care over prevention and health

promotion (2.2% of health budget of 60 billion US$; 10.8% of GDP)

  • Universal coverage with an extensive benefit package through

privately organized health insurances

  • Combination of private competition and state regulation

(“regulated market model”)

  • Historically grown highly fragmented care system (e.g. 350

hospitals and mostly individual physician practices)

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Out-of-Pocket 21% Basic health insurance 42% Social security 3% Other social insurances 7% Other private 1% Voluntary complementary health insurance 10% Subsidies of hospitals etc. 16% Premium subsidies (federal, cantonal) 6% Premiums Social Health Insurance 30% Co-payment 6%

Financing of Swiss Health System (2009)

Total: US$ 60 billion

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Applied Leadership Enterprise Performance Performance Improvement

People Systems

HARVARD UNIVERSITY

TMIT HCC

LEAD: Leadership Engagement And Development

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Overall costs could be lowered if the Swiss public wanted to:

  • 100% enrolled in HMOs, costs would drop

39%.

  • If 100% enrolled in high deductible, costs

would be 18% lower.

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Future Challenges Increase transparency in health outcomes Create integrated health care systems Provide enough health professionals Strengthen prevention and health promotion

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Thank you for your attention!

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Literature

  • Statistik der obligatorischen Krankenversicherung 2007, Bundesamt fuer

Gesundheit 2008.

  • OECD Health Data 2009. URL:

http://stats.oecd.org/Index.aspx?DatasetCode=HEALTH

  • Federal Office of Public health. URL:

www.bag.admin.ch/org/index.html?lang=en

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General government expenditure on health as percentage of total government expenditure

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General government expenditure on health as percentage of total expenditure on health

0% 20% 40% 60% 80% 100% 45.80% 59.10% General government expenditure on health

Total expendit

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Total expenditure on health as % of GDP

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Financing of Swiss Health System (2009)

Total: US$ 60 billion Sources: 1/3 basichealthinsurances 1/3 taxes 1/3 out of thepocket