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Friday, June 22, 2007

Soaring costs threaten universal coverage in Switzerland

By Alice Dembner, Globe Staff

While Massachusetts is the first state to require every adult to have health insurance, Switzerland led the way internationally, imposing a similar mandate on its 7.4 million residents in 1996.

Like the Massachusetts law, the Swiss initiative did not include any significant cost containment measures and that is one of Switzerland’s biggest mistakes, according to Ruth Dreifuss, who was a top official in the Swiss government.

Speaking today at a forum about the Swiss plan and its lessons for Massachusetts, Dreifuss said the cost of healthcare has soared, and with it, the price of premiums and the cost to taxpayers of insurance subsidies for low-income people.

About one-third of the Swiss people get subsidies. And some of those who don’t are paying as much as 16 percent of their income for healthcare, according to Beatrice Schaad Nobel, a Swiss journalist who also spoke and who just completed a report on the Swiss program for the Massachusetts Health Policy Forum, a nonprofit group that aims to improve healthcare here. The Forum and Health Care for All sponsored the talk.

The Swiss initiative has brought universal coverage and continues to have broad support, Dreifuss said. But "a system with no cost containment is not a sustainable one," she added. "I am worried about the future."

What can be done? The Swiss are still trying to figure that out. But Dreifuss said more managed care is one possibility, as well as setting up a government system to pay for the largest healthcare costs. The latter suggestion, called reinsurance, has also been floated here, but rejected so far on both sides of the ocean.

Nobel also suggests that unfettered competition among insurers might help, as well as larger copayments for patients who opt out of managed care programs that control access to specialists and hospitals.

In Massachusetts, the issue of cost control has been left to a newly appointed Quality and Cost Council, which has just set goals for this year that include finding ways to prevent unnecessary hospital stays and providing consumers with comparative cost data on hospitals.

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