Knižnica: The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets

This paper provides an overview of the Swiss and Dutch health insurance systems. Both countries have developed a system featuring universal insurance coverage based on individual mandates, consumer choice of health plans, regulated insurance market competition, and funding schemes that make coverage affordable for low- and middle-income families. Differences of both systems include degree of centralization, basis of competition among insurers, availability of managed care, and reliance on patient cost-sharing to influence care-seeking behavior. Residents in both countries are required to enroll with a private insurance provider in a basic plan offering a regulated package of benefits. In each country, insurance companies compete on cost, and online resources offer easy comparison for consumers. Insurers are required to accept all applicants for the basic package. To discourage risk selection, a central fund distributes premiums based on a risk equalization scheme. In Switzerland, the risk equalization formula is relatively simple, accounting only for age and gender. There is widespread agreement that this approach fails to adjust adequately for health risk. The formula will be modified substantially as of January 2012. In the Netherlands, the risk equalization scheme is sophisticated and complex, with the goal of compensating insurers fairly if plans attract higher health risk populations and fostering insurance competition based on care system performance.

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