Expat guide to Switzerland health care

No ome wants a medical operation save the attentionseeker with Munchausens syndrome But if you need one Switzerland is as good a place as any Provided you arent paying
Switzerlands carefully burnished image of high quality alongside high cost is well preserved within medicine Its hospitals and primary care are first class while overall expenditure on health is at the top end
The average Swiss citizen directly or indirectly through taxes spends US7141 a year on health Even Americans with a notoriously profligate and expensive health care system spend only a few dollars more a total of 7410 For comparison Britons have to muddle by on 3285
Highly regarded systems in Sweden 4252 and France 4798 manage on twothirds the Swiss spend These figures reflect exchange rates The disparity in costs between Switzerland and other European nations is not so great by another measure the proportion of national wealth spent of health In Switzerland total health spending amounts to 114 per cent of GDP US 174 per cent UK 98 per cent
Long lives
The Swiss may mutter about the cost of health care but at least they get the dividends They munch through a fair bit of cheese love their chocolate smoke the odd cigar but still live longer than almost any other nation
Life expectancy is 82 years some two years longer than the major West European nations and Canada and four years longer than the United States
Infant mortality the primary yardstick of a countrys health service is a commendable 37 per 1000 live births UK 46 per 1000 live births
How does the system work
Everyone in the country must in law buy and maintain health insurance giving a high standard of benefit The 1994 Federal Health Insurance Act lays down an impressive scale of benefits They cover sickness maternity and accidents
However although the system is universal it is administered by the canton in which the individual resides or sometimes in which he or she works
Within each canton there are usually two or more insurance providers or sick funds some 80 in all across the country This provides an element of competition but limited because provision of benefits is the same for all Sick funds are not allowed to make a profit running on a similar basis to Britains friendly societies dating from Victorian times
However true competition does exist in a further branch of insurance that of providing top up to cover claims not met or not fully met through the national Swiss health insurance scheme
Paul Tidy who set up Bupa Internationals current operation in Switzerland said Each canton will have two or more sickness funds and there will be contracts in place between the sickness funds and local hospitals in that canton
As the terms and conditions of the policies provided by the sickness funds sell are defined by law the only variation is pricing and that reflects the local risk Plans are community rated in common with many continental systems meaning there are no variations for age or sex among those aged over 26 Someone of 80 pays the same as 30yearold
Average premiums
Premiums have increased by about five per cent a year over the past decade In 2010 the average premium across the cantons for anyone aged over 26 was Sfr350 240 For someone 1925 it was Sfr293 and for those under 19 Sfr84
Excesses and charges
Cantons allow individuals to reduce their premiums by up to 40 per cent in some cases by taking out an excess on their policy Excesses known also as deductibles or franchises work on the same basis as car insurance with the insured party paying the first slice of a claim
Everyone who has medical care pays the first 10 per cent of the cost of treatment in all cases This copayment is capped to protect those facing huge bills such as the result of a catastrophic accident
Expats get threemonth leeway
Expats must register with their canton within three months of arriving in Switzerland Holding an international plan is no excuse for not doing so
Mr Tidy head of global partnering at Bupa International explained Some of the costs of the health care system are borne by the canton itself which is why if you are an expat moving into the country you have to go to the residency office of the local canton and they will say whether you need a local policy and or whether they will recognise your international policy
Its part of the procedure checking that you have medical insurance with one of the sickness funds or whether they are willing to accept your international policy in lieu of a policy with the sickness fund
It is common for people to have some sort of topup cover You tend to find that employers do not provide private insurance cover because they contribute to the sickness funds
Globetrotters
The large number international foreign civil servants NGO staff and members of permanent missions based in cities such as Geneva are exempted from compulsory insurance They can join the state health system after six months residency
For foreign nationals who travel widely abroad it is not so simple If their international cover is not deemed adequate for Swiss law and cantons can be inconsistent in what they are willing to rubber stamp globetrotters may end up with two policies Doubly insuring is clearly not ideal But for a Swissbased expat who spent half the year outside the country and wanted full protection it might be unavoidable
Mr Tidy commented He could obviously opt for a local plan and supplement it with travel insurance but that usually doesnt pay for elective treatment overseas
Globetrotters would need to check that any international policy held good for wherever they went in case they had a flareup of an existing condition
You would be doubly insuring if your canton did not recognise your international policy he continued It depends on the benefit limits and we do have policies at levels of benefits that some cantons will recognise but the process is highly variable We provide our members with a separate lettercertificate they can give to their canton that sets out the benefits of the policy and the caps
Most people end up with a local policy while using an international plan as a topup You get some good benefits under the state plans maternity checkups limited dental and so they are relatively comprehensive
Mr Tidy added Recognition is decided on a casebycase basis and will depend on your employment status whether you are a student or a retiree because you work with a different part of the social security system And it does depend where you are living and working
Employers pay into the national scheme with some of this contribution also going to welfare benefits rather as in National Insurance in Britain
Many people working in or near Geneva live in France where property is cheaper and commute daily across the border Mr Tidy said The Swiss authorities may accept they are covered under whatever policy they have or they insist they have a local policy in the canton where they are working
Some insurers wont cover Switzerland
Carl Carter chairman of the Association of International Medical Insurance Providers confirms the view of wide differences between cantons in interpreting federal rules This is hardly surprising as cantons partially finance the health scheme and have an interest in limiting liabilities
Mr Carter who is also managing director of insurers IMG Europe commented that some international insurance companies declined to cover Swissbased expats
However it could be perilous for an expat who resides in Switzerland to rely only on a local Swiss health care plan he said While that may or may not provide good coverage and access to insured services in Switzerland it would not provide them with evacuation and repatriation coverage it would not allow them access to health care outside of Switzerland or to return home for treatment plus most importantly for when they do finally move back home or relocate to another expat assignment theyll need to take out a new policy
Such a scenario could leave the individual uninsurable he continued If they have incurred costs or had preexisting conditions or ongoing claims in Switzerland this may make them uninsurable or severally financially exposed
International premiums
Even so for those paying for expensive international insurance themselves rather than an employer the temptation must be to stick with the Swiss national plan and supplement with travel cover Repatriation cover could be considered a disposable luxury in a country providing excellent medicine
For young adults doubly insuring international plans look good value against the Swiss federal system This is because commercials plans are not carrying the old and middleaged as they do with the communityrated Swiss system But of course such a strategy depends on getting the international plan approved
In 2012 a 25yearold in the Swiss system would now pay about 2676 a year A current Bupa International Classic plan would cost the same individual 1940 a year Cheaper but also less likely to meet stringent Swiss benefit requirements would be Aviva International Solutions Core which has reduced outpatient cover at 1245 a year for the 25 yearold InterGlobal Ultra comes in cheaper still at 979
The cost of the Swiss system and international premiums start equalising at about the age of 45
A lesson for others
The Swiss health care system is held up by some as an example of how to manage provision in the face of mounting demand The 1994 Act sought perfect managed competition with full coverage in basic health insurance The idea was to lay down substantial minimum benefits for all but encourage competition between insurers
At the same time the elements of copay and excesses give an incentive to patients to economise
Its fair to all The old or those in illhealth cannot be discriminated against in law because of open enrolment and community rating of premiums Waits for treatment are few new and expensive drugs are readily available under prescription Medical and nursing care whether in hospital or at home is to a high standard As developed countries come under ever greater financial squeeze the Swiss system offers a credible blueprint

Date : 18 May, 2012
Reference : www.telegraph.co.uk/health/expathealth/9264375/Expat-guide-to-Switzerland-health-care.html

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