The Santesuisse’s Influence on the ACA, Reaction Paper Example

Due to differences in culture and finances, health care systems vary from country to country.  Switzerland is known to have an effective model of health care coverage for its citizens.  Many Swiss citizens are covered by health insurance and content with their coverage.  Though it differs from the current health insurance system in the United States, the Patient Prevention and Affordable Care Act (ACA) may adapt certain aspects of the Swiss health care system as a model for the future of health insurance in the United States.

The current Swiss health care system, or Santesuisse, was originated in 1994 and implemented in 1996 under the Health Insurance Law (LAMal).  In Switzerland, citizens are required to purchase their own health insurance, as it is not provided by the government or employers.  In the United States, many people receive health insurance through their employers or the government.  According the United States Census (2012), the percentage of people covered by their employers is 45.1%, the government covers 32.2% of health insurance, and Medicaid covers 16.5%.  This trend may not be changing with the new health care laws.  Because the ACA will mandate that employers cover health insurance for their employees, the majority of citizens in the United States will still receive coverage through their work.  For those who are self-employed, not working, or are unable to afford health insurance, the government will have to provide assistance.

To ensure that all of its citizens are covered, the Swiss government mandates citizens purchase a basic package of health insurance.  Citizens are able to purchase private insurance in addition to the basic package required by the government.  The Santesuisse is meant to encourage competition while meeting the basic needs of each citizen’s health care.  The Santesuisse’s basic package of health insurance helps to control the costs of health care while covering all citizens.  Insurers must cover pre-existing conditions, be non-discriminatory of applicants, and operate as a non-profit entity.  The open enrollment policy requires that all applicants, regardless of health status must be accepted.  This is very different from health care in the United States where many are denied insurance due to pre-existing conditions and poor health status.   The ACA will require the insurance companies to have an open enrollment policy as well.  No one will be denied coverage due to poor health status or a preexisting condition.

The Santesuisse helps to keep overall health care costs down because citizens have better access to preventative care and are able to detect dangerous conditions earlier and receive more effective treatments.  When citizens have health insurance, they are more likely to have regular check-ups, physical examinations, and receive the therapies and treatments recommended by their physicians.  If emergencies do arise, most uninsured people will access necessary health care; the expense of this is often high and the cost may have been less if a person would not have waited.  For example, if a patient was found to have high blood pressure and cholesterol, it is much cheaper and easier for a physician to work with diet, exercise, and even medication as opposed to a visit to the emergency room for chest pains or myocardial infarction.

Many Swiss citizens choose to purchase supplemental insurance if they want access to health care outside of their basic package.  To save on monthly premiums, supplemental plans with higher deductibles are often chosen.  Even though health insurance can be expensive, many Swiss purchase additional insurance because the basic package can be restrictive.   Like most managed care systems, the government issues what treatments are medically necessary and cost-effective.  Citizens are only able to seek treatment in their cantons, which are regions similar to states, and may not be able to be treated in for-profit hospitals which are not accredited for receiving reimbursement.   Purchasing additional insurance also allows access to alternative medicine and private hospital rooms.  Citizens with the supplemental insurance are free choice to be treated wherever and by whomever they desire.

Insurers also have an advantage with supplemental insurance.  While they must adhere to

the government’s rules with the mandated health care package, they are allowed to be discriminatory and deny people for health status and pre-existing conditions.  Supplemental insurance also allows for insurers to profit from their policies.

There are some concerns over the health care system in Switzerland.   The premiums for the mandated basic package have increase by 5% and may make it unaffordable for some Swiss.   To remedy this, the Swiss government subsidizes the cost of health insurance if the cost rises above 8% of their income.  In order to receive supplemental insurance, such as Medicaid, in the United States, citizens must receive a certain level of income.  And even though this helps the poor receive health care, there are many citizens in the United States who make just enough income so that they are above the federal poverty line.  While their income disqualifies them for any assistance, it does not allow them to afford health insurance along with other basic needs.  In Switzerland, the average citizen is more likely to be able to afford to purchase their own insurance, because they overall have more wealth and income than the average citizen in the United States.  According to the US census (2011), the median income for family households has declined approximately 1.7% from 2011 to 2010, making this decline the fourth year where income has consecutively decreased.

The Santesuisse is increasing benefits for the Swiss in the basic package and this raises some financial concerns for increasing health care costs.  Some would prefer to marginalize coverage for less common complications in the basic care package.  Patients with lower costs would be prioritized over those who had ill health in order to maximize profits.  Because this would encourage discrimination for people with pre-existing conditions and poor health, this marginalization likely be negated.  The basic package currently calculates health risks based on sex and age, not accurately accounting for overall health.  The ACA would calculate risks and adjust premiums due to factors such as family structure, age, geography, tobacco use, and participation in health promotion programs.

The cost of health insurance in Switzerland is less than in the United States.  Citizens in the United States receive more government assistance for health insurance.  According to Forbes (2012), the Swiss government spends 2.7% GDP where 7.4% is spent on GDP in the United States.  In addition to subsidizing health care costs beyond 8% of income, the Swiss government provides health care coverage for the citizens who are unable to afford it.  Because of this system, 99.5% Swiss citizens have health care and insurance companies must compete on prices and services.  In 2011, the United States Census recorded the number of uninsured people at 15.7%.

People do not have insurance in the United States because they do not receive it through their work and make too much income for assistance; yet they cannot afford basic health care coverage.  A mandate that requires citizens in the United States to purchase their own insurance or face a penalty is a concern that the ACA must address.  To provide assistance, each state will establish an Exchange for tax credits to insure individuals and small businesses have access to health care.

Though there is speculation of the United States moving towards a system more similar to the Santesuisse, it is unlikely to occur.  Even with the onset of the ACA, the systems for health insurance are dramatically different. Other than the mandate that all citizens have health care and the open enrollment policy, the ACA is very different from the Santesuisee.  Citizens in the United States would still require health insurance to come from either their employers or the government.  The ACA may even deepen the need for this reliance.  The ability of the Swiss to purchase their own health insurance could be due to the fact that they would rather avert risk or that they have greater incomes than the average citizen in the United States.  The Santesuisse may serve as an ideal for the ACA; due to the cultural and economic differences between Switzerland and the United States, the differences between the two health care systems will continue to exist.



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