Hacker News Reader

Comment by oceanofsolaris | Hacker News Reader

Basic health insurance in Switzerland is “private” but very regulated:

All companies offer completely exchangeable plans and are only allowed to take age, municipality and desired copay into account when calculating your premium. Every resident of Switzerland is also obligated to have this basic health insurance (if you don’t, the government just picks a random insurance for you and signs you up retroactively).

I would say it’s a great system…but Swiss health care costs are also among the highest in the world (and rising steeply), so it’s not a silver bullet.

To be fair, this particular system is probably not to blame for the high costs, but it also didn’t prevent them (though it leads to a bit of innovation around e.g. telemedicine, which is great).

View on HN

> but Swiss health care costs are also among the highest in the world (and rising steeply),

But relative to GDP Swiss healthcare spending is lower than in Germany or France. Adjusted by PPP they aren’t even that much higher in absolute terms than in most other richer European countries. Of course there are some outliers like Denmark but if we consider income levels and outcomes healthcare in Switzerland seems relatively “cheap”.

> But relative to GDP Swiss healthcare spending is lower than in Germany or France.

But, sure, healthcare is a mix of labor and materials like most things, and the labor cost should scale loosely with local GDP per capita, but to the extent tradeable the materials cost shouldn't and should follow the law of one price, so Switzerland, with almost twice Germany's per capita GDP (and more than twice France’s) should have lower healthcare costs as a share of GDP, all other things being equal, because for the same mix of goods and services, the per-GDP materials costs is naturally lower.

They'd have to be doing something really wrong [0] for that not to be the case.

[0] like the U.S. is

The high costs can be easily traced to the insurers lobby. See their late huge profits while at the same time raising the prices because muh costs... all passing basically unchallenged even at the recent elections - not even by the left parties. While it's better than in many other places in the world, still we should complain, if only for awareness.

Health insurer profit margins are 2% to 6% (objectively not huge). Their medical loss ratios are 85% to 90% (the proportion of their revenue that gets paid to healthcare providers).

Let’s suppose they are eliminated completely. You save 15% at most from not paying insurers, and let’s say doctors’ offices spend 10% on all the paperwork dealing with insurance.

However, government employees have to do some of the same jobs as the insurance company employees, such as identifying overcharges/fraudulent charges, etc. Add 10% back for that work (5% on government side, 5% on provider side since it should be less paperwork since it’s only 1 entity they are dealing with).

So all in, that is 15% savings, in an ideal case. With 90% medical loss ratios, it is 10% savings (more likely).

Reply on news.ycombinator.com