University of Lucerne, Switzerland; CSS Institute for Empirical Health Economics, Lucerne, Switzerland.
University of Lucerne, Switzerland; CSS Institute for Empirical Health Economics, Lucerne, Switzerland; University of Zurich, Switzerland.
Health Policy. 2020 Dec;124(12):1363-1367. doi: 10.1016/j.healthpol.2020.08.011. Epub 2020 Sep 17.
The Swiss healthcare financing system is on the verge of one of its largest reforms. The Swiss parliament is currently debating how to reallocate about 20 % of total health expenditures. Swiss cantons make substantial tax-funded contributions to health expenditures by paying 55 % of hospital inpatient costs. As health insurers are fully responsible for all outpatient costs, the present system may provide unintended incentives to treat patients in inpatient settings. This paper presents and evaluates three alternative reform proposals for the reallocation of the cantonal contribution. Two proposals are currently under consideration in the Swiss parliament, suggesting either partial cost-sharing (20 %) of all healthcare costs or inclusion of cantonal contributions into the risk-equalization fund. A third option is developed in this paper, which proposes using the cantonal funds to pay a share of insurer's expenses above a high-cost threshold. The high-cost risk-sharing alternative is clearly superior: it mitigates the incentive to discriminate against sicker individuals, improves incentives for cost control, and reduces risk of loss for insurers. The paper adds results from Switzerland to an international literature on the properties of adding high-cost risk sharing to a risk equalization model.
瑞士的医疗保健融资系统正处于其最大规模改革之一的边缘。瑞士议会目前正在辩论如何重新分配约 20%的总医疗支出。瑞士各州通过支付 55%的住院病人费用，为医疗支出提供了大量的税收资金。由于医疗保险机构完全负责所有门诊费用，因此现行制度可能会为在住院环境中治疗病人提供意想不到的激励。本文提出并评估了重新分配州贡献的三种替代改革方案。瑞士议会目前正在审议两项提案，建议要么对所有医疗费用进行部分成本分担（20%），要么将州的贡献纳入风险均衡基金。本文还提出了第三种选择，即利用州资金支付高于高成本门槛的保险公司费用的一部分。高成本风险分担方案明显具有优势：它减轻了歧视病情较重者的激励，改善了成本控制的激励，并降低了保险公司的损失风险。本文将瑞士的结果加入到有关向风险均衡模型中加入高成本风险分担的国际文献中。
