Health and Medical Information for Switzerland
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Switzerland is a mountainous country located in central Europe and bordered by France to the west and northwest, Germany to the north, Austria and Liechtenstein to the east and Italy to the south. Officially known as the Swiss Confederation, the nation is a federal republic consisting of 26 cantons, each with their own constitution, legislative and executive bodies. The population (just under 8 million) is made up of an eclectic mix of four principle language communities: German, French, Italian and Romansh. Switzerland is one of the richest countries in the world with several of its cities, Geneva, the capital Berne and Zurich, home to prominent international organizations. Those traveling to Switzerland can experience sophisticated modern cities, a unique collaboration of Europe’s great cultures and the best ski resorts and alpine activities the picturesque Alps can provide.
Switzerland is world renowned for the superior quality and efficient delivery of its health care services for its citizens. There is an extensive network of hospitals and doctors, waiting lists are rare and medical facilities provide the latest technology for treatment. Health care has always been high on the public agenda. The federal government provides oversight of the system, and the individual cantons are responsible for regulation and financing of the public delivery system. Switzerland operates the second most expensive health care system behind the United States, with health care expenditure consistently totaling over 10% of the GDP. This considerable investment has enabled the country to posses a wealth of first class medical facilities, as well as one of the world’s lowest patient-to-doctor ratios (280:1) with an additional high ratio of well-trained nurses to doctors.
The high level of healthcare in Switzerland comes at a cost. Everyone living in the country is mandated, under the 1996 Health Insurance Law, to purchase basic health insurance from among competing non-profit health funds. Foreigners must obtain health coverage within the first three months upon their arrival in Switzerland and babies must be insured within three months of birth. There are virtually no uninsured persons in Switzerland. Insurance is individual and does not extend to one’s dependents nor is it sponsored by employers. Citizens are free to use any insurance company for the basic package, providing it is registered with the caisse-maladie or Krankenkasse, and is approved by the Federal Act, which governs healthcare policy. The basic insurance package covers most GP and specialist services, certain pharmaceuticals, and some preventative measures. The insurance companies providing this plan vary in size from a couple thousand members to well over a million.
Each person must cover part of their treatment themselves by paying an annual excess known as the franchise on their health insurance policy. The more franchise you pay, the lower your monthly premiums. Health insurance premiums in Switzerland are not dependent on income, but are calculated based on personal risk profile. Different insurance company health plans cannot compete through benefit packages, but rather through comparative premiums and deductible pricing. These prices may vary considerably between cantons, as they are community-rated. The insurance companies will calculate their premiums based on estimates of health care expenditure specific to a canton or sub region within. For example: cantonal average premiums ranged between $2,689 in Nidwalden to $4,911 in Geneva in 2009. Costs are redistributed among health insurers from a central fund according to a risk equalization scheme based on age and gender. As of 2012, this format will also take into account hospital and nursing home stays of more than three days in the previous year.
Many Swiss residents also purchase supplementary private insurance to cover additional services not covered under the basic compulsory package, including dental treatment, private ward hospitalization and other medical options available outside their canton. Unlike insurers offering the basic coverage plan, private insurers can be for-profit. Often an insurance company in Switzerland will have a non-profit branch offering mandatory public insurance and a for-profit branch offering additional private medical insurance.
Switzerland features a robust network of medical care providers. Hospitals and outpatient care are operated by public (cantons, local authorities), or private institutions. In 2003 there were 354 hospitals in Switzerland. Of those 220 were public or publicly subsidized (not-for profit) private. Five were university hospitals, offering tertiary treatment. With 5.8 beds per 1000 population, the Swiss are well supplied with hospital beds. Most inpatient treatment is provided in cantonal or regional public hospitals. These public hospitals initial investment costs are financed through the cantons and then operating costs are split equally between themselves and the health insurance companies. Cantons maintain a list of accredited hospitals that meet certain standards and are entitled to reimbursement under the compulsory insurance system. Private hospitals do not receive any financial subsidies but are funded solely by payments made by the health insurance companies and patients. Doctors in independent practice provide most ambulatory primary health care. Medical practitioners are paid on a fee-for-service schedule negotiated between insurers and providers or their organizations at the canton level. Over a third of all Swiss pharmaceuticals are listed to be reimbursed by basic insurance, subject to a 10% co-payment. All other drugs are either paid for in full by patients, or by supplementary insurers if applicable.
Swiss medical facilities and health care are among the best in the world, but very expensive and health insurance is recommended. Even emergency care is not available free and once your condition is stabilized you will have to pay up or provide proof of your insurance status. After visiting a hospital or doctor, you will receive a bill which you should pay within a 30 day period. You would then send a copy to your insurance company, which will reimburse based upon the percentage covered by your insurance scheme. If you are not a qualified resident in Switzerland and don’t have any sufficient health insurance, hospitals will require a substantial deposit upon your admittance into a health facility. Whilst traveling or working in Switzerland, in order to give you and your family full protection on healthcare, it is recommended to put in place an International Health Insurance plan. Coverage is especially important if you will be climbing or skiing and one should make sure these activities are covered under your insurance policy.
If European visitors or any of their dependants are suddenly taken ill or have an accident during a visit to Switzerland, free or reduced-cost necessary treatment is available; in most cases on production of a valid European Health Insurance Card (EHIC). Full travel insurance is advised for all travellers.
Other risks:
No immunisations are required to enter Switzerland, although it is advisable to make sure your tetanus, diphtheria and polio vaccinations are up to date before travelling. A certificate of immunisation against contagious diseases (including Yellow Fever) is required before the traveller can enter the country if they have been in an infected area within 14 days prior to arrival in Switzerland. Rabies is present, but extremely rare. However, if you are bitten, seek medical advice without delay.
