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Swiss blend of public and private health care results in lower wait times, less cost than Canada

By Contributor
August 13th, 2013

If Canadians are truly interested in improving the nation’s health care system, reducing wait times for treatment, and maintaining universal access to care, then Canada should emulate the Swiss health care system, concludes a new report from the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“The Swiss health care system provides health care to all its citizens with minimal wait times at a lower cost than Canadians pay,” said Nadeem Esmail, Fraser Institute director of health policy studies and author of Health Care Lessons from Switzerland.

“Any discussion of changing the Canadian health care system too often gets bogged down in fear-mongering about the American system. The United States is not an example Canada should follow, instead we should be looking to countries like Switzerland for examples of success.”

Health Care Lessons from Switzerland is part of a Fraser Institute series examining the way health services are funded and delivered in other developed countries where health care is available to all citizens regardless of a person’s ability to pay.
In comparing age-adjusted performance of the Canadian and Swiss health care systems, the report highlights some startling differences:

The Canadian system is much more expensive, consuming 12.5 per cent of GDP compared to 10.8 per cent in Switzerland. Switzerland also has more physicians (3.6 per 1,000 people compared to Canada’s 2.6); more nurses (14.4 per 1,000 people to 10.3 in Canada); and more CT scanners (31.0 per 1,000 people to Canada’s 15.2).

When it comes to wait times, 93 per cent of Swiss patients reported being able to obtain a same-day or next day appointment with a physician or nurse, compared to 45 per cent of Canadian patients; 82 per cent of Swiss patients waited less than one month for a specialist appointment compared to 41 per cent of Canadian patients; and 55 per cent of Swiss patients reported waiting less than one month for elective surgery compared to 35 per cent of Canadian patients.

The success of Switzerland’s health care system is a result of its blending of public and private options. Rather than relying on a tax-funded monopoly government insurer, the Swiss model provides universal coverage in an insurance premium-funded system characterized by competition between independent insurers, competition between providers, consumer choice of health plan characteristics, and a high level of consumer responsibility.

“Canadians need to get past the antiquated notion that private-sector participation in health care is something to be feared and avoided. Switzerland shows that private competition can be employed to deliver high quality, universally accessible hospital and surgical services,” Esmail said.

The Swiss system requires citizens to purchase individual universal health insurance coverage from, and pay insurance premiums to, one of Switzerland’s independent insurance companies. In this sense, the Swiss health insurance market is best characterized as one with ‘managed competition.’ Specifically, the provision of health care and health care insurance is largely in private/independent hands with the government maintaining a high level of regulation within which the industry operates. Swiss governments also ensure that low-income citizens have access to insurance by providing an income/wealth-based subsidy for the cost of health insurance.

Other key features of the Swiss system include:
• Cost sharing for all forms of medical services;
• Private provision of acute care hospital and surgical services;
• Activity-based funding for hospital care; and
• Permissibility of privately funded parallel health care.

“Copying the Swiss approach would require substantial reform of Canada’s health care system but Canadian provinces could implement several aspects of the Swiss system without violating the Canada Health Act,” Esmail said.

“The federal government has signalled that provinces have more freedom to experiment and try new approaches to providing health care. All Canadians would ultimately benefit if one of the provinces took these lessons from Switzerland to heart and implemented some of the policies found in the Swiss health care system.”

The Fraser Institute is an independent Canadian public policy research and educational organization with offices in Vancouver, Calgary, Toronto, and Montreal and ties to a global network of 86 think-tanks. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. To protect the Institute’s independence, it does not accept grants from governments or contracts for research. Visit

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