Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web
Switzerland Alberto Holly and Philippe Lehmann Economic trends • Switzerland's real GDP per capita contracted in 2009 but to a lesser extent than the mean contraction in the European region in that year. • Ten-year bond rates are the lowest in the European region. • While government spending relative to GDP is low compared with other European countries, priority for health spending is among the highest in Europe. In 2008, there was acceleration in public per capita expenditure growth to 18.5%; at the same time, OOP expenditure decreased by 12.4% (Switzerland: Figs 1 and 2). Policy responses Changes to public funding for the health system • The health budget at the national level was cut. • The annual rate of increase in SHI expenditure fell from 4.2% (1996–2001) to 3.2% (2001–2006) and 2.1% (2006–2011). • This reform aimed to prevent insurers from increasing premiums to compensate for investment losses, as occurred in 2010. • Federal and canton government subsidies for health insurance premiums for individuals with low income and families (available since 1996 and stable between 2005 and 2008) were increased (2009). • The government introduced new rules for health insurer minimum reserves, which are now set in relation to enrollee risk profiles rather than premium income (2012). • The annual rate of increase in SHI premiums fell from 6–9% (2000–2005) to 0–2% (2012–2013), mainly as a result of cost-containment measures. Changes to health coverage Population (entitlement) • Clarified entitlement of undocumented migrants: these persons are entitled to statutory coverage and subsidized premiums (2011).
496 Economic crisis, health systems and health in Europe: country experience % Switzerland: Fig. 1 Economic and fiscal indicators 2000–2007 and 2008–2011 60 55 50 45 40 35 30 25 20 15 10 5 0 −5 −10 −15 _ _ _ _ ● ● _ _ _ _ ● _ _ _ _ ● ● _ _ Real GDP per capita growth _ _ ● ● _ _ Deficit/surplus (% GDP) _ _ _ _ _ _ _ _ _ _ ● ● _ _ _ ● _ ● _ ● _ _ _ _ _ Government spending (% GDP) _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Government health spending (% total government spending) _ _ _ _ _ _ ● ● ● ● _ _ ● _ _ _ 10−year bond rates Notes: Deficit/surplus: World Bank; 10-year bond rates: IMF; Other indicators: WHO Health for All. Year 2000−2007 2008 2009 2010 2011 _ ● _ _ _ _ _ ● ● _ _ _ Unemployment rate Switzerland: Fig. 2 Trends in per capita spending on health, 2000–2011 Public spending per capita OOP spending per capita Non−OOP private spending per capita 3000 Per capita spending $, PPP 2000 1000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20 Growth % 10 0 −10 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Public spending per capita growth OOP spending per capita growth Non−OOP private spending per capita growth Note: Spending calculated from WHO Health for All.
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496 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />
%<br />
Switzerl<strong>and</strong>: Fig. 1 Economic <strong>and</strong> fiscal indicators 2000–2007 <strong>and</strong> 2008–2011<br />
60<br />
55<br />
50<br />
45<br />
40<br />
35<br />
30<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
−5<br />
−10<br />
−15<br />
_ _<br />
_ _<br />
● ●<br />
_ _<br />
_<br />
_<br />
●<br />
_<br />
_ _ _<br />
●<br />
●<br />
_ _<br />
Real GDP<br />
per capita growth<br />
_ _<br />
● ●<br />
_ _<br />
Deficit/surplus<br />
(% GDP)<br />
_ _ _ _ _<br />
_ _ _ _ _<br />
●<br />
●<br />
_ _<br />
_<br />
●<br />
_ ●<br />
_<br />
●<br />
_ _ _ _ _<br />
Government<br />
spending<br />
(% GDP)<br />
_ _ _ _ _<br />
● ● ● ● ●<br />
_ _ _ _ _<br />
Government<br />
<strong>health</strong> spending<br />
(% total government<br />
spending)<br />
_ _ _ _ _ _<br />
●<br />
●<br />
●<br />
●<br />
_ _ ●<br />
_ _ _<br />
10−year<br />
bond rates<br />
Notes: Deficit/surplus: World Bank; 10-year bond rates: IMF; Other indicators: WHO Health for All.<br />
Year<br />
2000−2007 2008 2009 2010 2011<br />
_<br />
●<br />
_<br />
_<br />
_ _<br />
_<br />
● ●<br />
_ _<br />
_<br />
Unemployment<br />
rate<br />
Switzerl<strong>and</strong>: Fig. 2 Trends in per capita spending on <strong>health</strong>, 2000–2011<br />
Public spending per capita OOP spending per capita Non−OOP private spending per capita<br />
3000<br />
Per capita spending $, PPP<br />
2000<br />
1000<br />
0<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
20<br />
Growth %<br />
10<br />
0<br />
−10<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
Public spending<br />
per capita growth<br />
OOP spending<br />
per capita growth<br />
Non−OOP private spending<br />
per capita growth<br />
Note: Spending calculated from WHO Health for All.
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