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Health Affairs Interview: Understanding The Swiss Health System



August 13th, 2010
by Chris Fleming

Switzerland has been “rediscovered” as a source of inspiration for the American health care system – which is somewhat ironic, since, as former Swiss health minister Thomas Zeltner tells Tsung-Mei Cheng in an August 2010 Health Affairs interview, Switzerland’s model of “managed competition” among private health insurance plans is rooted in the work of longtime Health Affairs contributor Allan Enthoven.

As Health Affairs Editor-in-Chief Susan Dentzer notes in her introduction to the journal’s August issue, titled Lessons From Around The World, “it’s not sensible to reduce another country’s complicated health system to just one or two bullet points.” As the Zeltner interview makes clear, Dentzer says, the Swiss system has

been governed by laws and regulations that place the emphasis on “management” as much as on “competition.” Specifically, Zeltner points to his nation’s requirement that health plans and providers negotiate with each other over prices—with the Swiss government watching over the negotiators’ shoulders and determining prices if negotiations fail.


Zeltner retired in December of last year after 19 years as head of Switzerland’s federal Office of Public Health (for national duties) and as secretary of health (for international activities) for nineteen years. He oversaw the health care overhaul Switzerland undertook in 1996, which has much in common with reforms now underway in the United States. In his interview with Cheng, Zeltner explains how the Swiss private health insurance system works, the significant regulatory role that the government plays in Swiss health care, the strengths and weaknesses of the Swiss health system, and what lessons his experience with that system holds for the United States

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1 Response to “Health Affairs Interview: Understanding The Swiss Health System”

  1. Jeff Goldsmith Says:

    This was a fascinating interview.

    Per Susan’s comment, the cost containment appears to come from price controls, not competitive pressures on the health system. It looks like the main function of the health plans is just to pay the bills. Pharmaceutical prices are set by the government and provider prices thru German style supervised collective bargaining between providers and health plans within government set price guidelines. No selective contracting, no risk sharing with providers, no organized care systems. And the Swiss pay out of pocket almost TWICE what Americans pay (28% vs. 15%) as a percentage of total spending. The Swiss are a long way from Alain Enthoven, but at least they got the employers out of the mix . . .

    Great job, May!

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