Maybe if we get rid of all the health insurance companies?
It’s always possible to do better.
I always wonder how these stats would look like when adjusted to cost of living or median income. Of course healthcare expenditure is higher in a country where everything costs more. Switzerland might still look like we overpay but it would certainly be less extreme.
Based on Singapore data, I would say yes. Singapore actually has a very similar social system than Switzerland and a very similar economy based on services, finance, immigration, etc (albeit smaller, it’s practically considered the Switzerland of Southeast Asia). It seems they have the same life expectancy and spend 1/3rd in healthcare. Whatever they do, we should probably take inspiration from.
There was a study in Germany quite recently, that quite a bit of the healthcare cost increase has to do with investment firms buying up doctor’s practices and then hiring doctor’s as employees. New doctors can’t pay the prices of practices, investment firms can.
And since the investment firms are in it for the profit and the doctor is just an employee, they are made to recomment unnecessary treatments, which increases costs in the medical sector.
Same thing happens in Switzerland, and also with retirement homes, where homes owned by investment firms reduce costs and list cleaning and facility management staff as nursing staff to reach minimum nursing staffing levels, which means there’s no time for staff to properly take care of residents and especially, have no time to socially interact with them.
Hmm…I’m actually “pro state insurance” (for the basic insurance that you have to get anyway). But being more or less on the same point as Norway in a graph doesn’t usually scream you are wrong…
The first correction on this graph would be to use PPP, %GDP, or some other method to adjust to local cost of living, salaries instead of using raw numbers
To answer the question though:
Cutting all non-evidence-based alternative therapies including homeopathy from the basic insurance would save a lot and have no effect on life expectancy
Many quite expensive treatments like physiotherapy and mental health care relate more to quality-of-life rather than absolute life expectancy, so if you really wanted to optimise for only life expectancy that could go. However having a load of people unable to work (who could with treatment) around would be bad, so even from economic grounds ignoring human cost that could go
In general still many deaths are due to preventable causes like smoking, alcohol, obesity and inactivity, so these could probably be reduced without costing money on the healthcare budget.
Yes
Besides the number criticism already done..
When you get a medicine recipe and the doctor does not indicate that it has to be that specific named product, ask for the cheapest generic they have. Same medicinal content, different colour.
But rather than save those savings, I would invest them back into the healthcare system in order to hire more doctors and nurses
Getting rid of insurance coverage of acupuncturists, naturopaths, homeopathy and chiropractors would shave a solid 30% of that while increasing average lifespan.
Yes, there is so much low value care that serves no beneficial purpose. For a start: Everyone please stop taking unnecessary lab tests ([like 25% of the population testing vitamins](https://pubmed.ncbi.nlm.nih.gov/33293852/)).
Working as a doc: yes, we could get down the costs a lot without losing quality. Some suggestions:
– actually apply the WZW-principle, and stop paying for stuff like homeopathy and other unproven shit. There are also studies that show that alternative care docs are at least 20% more expensive, so I think we’d need to really evaluate how they work.
– Basically do some kind of supervision for private practices. Currently docs have to show that they took some classes every year, but whether they change/update their practice, and whether their practice is done right is never assessed once you acquire your practice certification, and I think this is wrong.
– Pay more for prevention, e.g. stop-smoking programs and meds, more physiotherapy, rehabilitation, vaccination, talks about Patientenverfügung etc.
– Basically put AHV, IV, Arbeitslosenkasse + Health insurance in the same pot. We currently spend a lot of time as docs (and lawyers and other people’s time) on insurances fighting each other. If somebody has 2 different health conditions in a year requiring rehabilitation, they’ll only get one reha paid per health insurance. If they end up not working, it will end up costing IV or arbeitslosenversicherung or other insurances, but because this doesn’t have to be paid by the health insurance, they don’t really care about that. Also there are lawyers fighting each other whether something has to be paid by accident or health insurance, and that’s basically just stupid shit that doesn’t really help anybody. Also we have to fill out certificates because the health insurance wants to know if they could turf somebodys prostate cancer on the mother’s or military insurance, and we have to spend our time filling out sheets of paper saying that this doesn’t work.
– Make some kind of “BAG” to evaluate new healthcare options, e.g. new chemo drugs, new meds, new devices, and evaluate whether they actually are an improvement to what we already have, and if the health insurance should pay it. This should also be one institution in Switzerland, because currently it’s some kind of Vertrauensarzt evaluating stuff in each insurance, and they are not often even knowledgeable for the area they are deciding on, and also if you’re unlucky your insurance is not going to pay for a new, good chemo, and if you were insured by another insurance, they would.
– Also actually make patients kind of responsible for their treatment. Basically: we should not be paying for expensive drugs if patients don’t take them regularly, or we should not be funding expensive drugs e.g. for lung diseases while the patient continues to stop smoking. Last week we had a patient who got a new, expensive drug for asthma, and it worked so good they stopped their inhalations and started smoking again, and I’m – as a payer of health insurance – I think we should just stop funding the drug if people don’t adhere to the treatment because they are just not willing to even do a little bit of work themselves.
– Digitalisation: make a standard for labs/images/documents, force all practices and hospitals to adhere, and have some kind of care manager to sort stuff out for individual patients until all the stuff is in the system. But currently we are often forced to do labs or images or stuff several times, because we don’t have access to prior information.
You can improve it by reducing levels of obesity, improving diet and exercise, reduce levels of drugs and smoking and increasing the amount of young people as they finance the old people.
How many % of GDP is that?
Remove dental care, ahh wait!
Healthcare in Switzerland is surprisingly bad and somehow backwards. Compared to Iceland or Norway where doctors are down to earth and are humans in Switzerland they just see you, say nothing, look at their notes and peace out lol. Not all doctors but quality of healthcare has gone down, I think after Covid things got even worse people are so f rude.
16 comments
Maybe if we get rid of all the health insurance companies?
It’s always possible to do better.
I always wonder how these stats would look like when adjusted to cost of living or median income. Of course healthcare expenditure is higher in a country where everything costs more. Switzerland might still look like we overpay but it would certainly be less extreme.
Based on Singapore data, I would say yes. Singapore actually has a very similar social system than Switzerland and a very similar economy based on services, finance, immigration, etc (albeit smaller, it’s practically considered the Switzerland of Southeast Asia). It seems they have the same life expectancy and spend 1/3rd in healthcare. Whatever they do, we should probably take inspiration from.
There was a study in Germany quite recently, that quite a bit of the healthcare cost increase has to do with investment firms buying up doctor’s practices and then hiring doctor’s as employees. New doctors can’t pay the prices of practices, investment firms can.
And since the investment firms are in it for the profit and the doctor is just an employee, they are made to recomment unnecessary treatments, which increases costs in the medical sector.
https://daserste.ndr.de/panorama/archiv/2022/Spekulanten-greifen-nach-Arztpraxen,arztpraxen112.html
Same thing happens in Switzerland, and also with retirement homes, where homes owned by investment firms reduce costs and list cleaning and facility management staff as nursing staff to reach minimum nursing staffing levels, which means there’s no time for staff to properly take care of residents and especially, have no time to socially interact with them.
Hmm…I’m actually “pro state insurance” (for the basic insurance that you have to get anyway). But being more or less on the same point as Norway in a graph doesn’t usually scream you are wrong…
The first correction on this graph would be to use PPP, %GDP, or some other method to adjust to local cost of living, salaries instead of using raw numbers
To answer the question though:
Cutting all non-evidence-based alternative therapies including homeopathy from the basic insurance would save a lot and have no effect on life expectancy
Many quite expensive treatments like physiotherapy and mental health care relate more to quality-of-life rather than absolute life expectancy, so if you really wanted to optimise for only life expectancy that could go. However having a load of people unable to work (who could with treatment) around would be bad, so even from economic grounds ignoring human cost that could go
In general still many deaths are due to preventable causes like smoking, alcohol, obesity and inactivity, so these could probably be reduced without costing money on the healthcare budget.
Yes
Besides the number criticism already done..
When you get a medicine recipe and the doctor does not indicate that it has to be that specific named product, ask for the cheapest generic they have. Same medicinal content, different colour.
But rather than save those savings, I would invest them back into the healthcare system in order to hire more doctors and nurses
Getting rid of insurance coverage of acupuncturists, naturopaths, homeopathy and chiropractors would shave a solid 30% of that while increasing average lifespan.
Yes, there is so much low value care that serves no beneficial purpose. For a start: Everyone please stop taking unnecessary lab tests ([like 25% of the population testing vitamins](https://pubmed.ncbi.nlm.nih.gov/33293852/)).
Working as a doc: yes, we could get down the costs a lot without losing quality. Some suggestions:
– actually apply the WZW-principle, and stop paying for stuff like homeopathy and other unproven shit. There are also studies that show that alternative care docs are at least 20% more expensive, so I think we’d need to really evaluate how they work.
– Basically do some kind of supervision for private practices. Currently docs have to show that they took some classes every year, but whether they change/update their practice, and whether their practice is done right is never assessed once you acquire your practice certification, and I think this is wrong.
– Pay more for prevention, e.g. stop-smoking programs and meds, more physiotherapy, rehabilitation, vaccination, talks about Patientenverfügung etc.
– Basically put AHV, IV, Arbeitslosenkasse + Health insurance in the same pot. We currently spend a lot of time as docs (and lawyers and other people’s time) on insurances fighting each other. If somebody has 2 different health conditions in a year requiring rehabilitation, they’ll only get one reha paid per health insurance. If they end up not working, it will end up costing IV or arbeitslosenversicherung or other insurances, but because this doesn’t have to be paid by the health insurance, they don’t really care about that. Also there are lawyers fighting each other whether something has to be paid by accident or health insurance, and that’s basically just stupid shit that doesn’t really help anybody. Also we have to fill out certificates because the health insurance wants to know if they could turf somebodys prostate cancer on the mother’s or military insurance, and we have to spend our time filling out sheets of paper saying that this doesn’t work.
– Make some kind of “BAG” to evaluate new healthcare options, e.g. new chemo drugs, new meds, new devices, and evaluate whether they actually are an improvement to what we already have, and if the health insurance should pay it. This should also be one institution in Switzerland, because currently it’s some kind of Vertrauensarzt evaluating stuff in each insurance, and they are not often even knowledgeable for the area they are deciding on, and also if you’re unlucky your insurance is not going to pay for a new, good chemo, and if you were insured by another insurance, they would.
– Also actually make patients kind of responsible for their treatment. Basically: we should not be paying for expensive drugs if patients don’t take them regularly, or we should not be funding expensive drugs e.g. for lung diseases while the patient continues to stop smoking. Last week we had a patient who got a new, expensive drug for asthma, and it worked so good they stopped their inhalations and started smoking again, and I’m – as a payer of health insurance – I think we should just stop funding the drug if people don’t adhere to the treatment because they are just not willing to even do a little bit of work themselves.
– Digitalisation: make a standard for labs/images/documents, force all practices and hospitals to adhere, and have some kind of care manager to sort stuff out for individual patients until all the stuff is in the system. But currently we are often forced to do labs or images or stuff several times, because we don’t have access to prior information.
You can improve it by reducing levels of obesity, improving diet and exercise, reduce levels of drugs and smoking and increasing the amount of young people as they finance the old people.
How many % of GDP is that?
Remove dental care, ahh wait!
Healthcare in Switzerland is surprisingly bad and somehow backwards. Compared to Iceland or Norway where doctors are down to earth and are humans in Switzerland they just see you, say nothing, look at their notes and peace out lol. Not all doctors but quality of healthcare has gone down, I think after Covid things got even worse people are so f rude.