Equity of access to care and health insurance choice in Switzerland
Notice bibliographique
Résumé
Among public health experts Switzerland is known for its quality of care. In international comparison, the country ranks highly in life expectancy at birth and mortality rates for treatable causes. However, the cost of healthcare is high and private households pay an important share of expenditure, either through health insurance premiums or out-of-pocket expenditure. The heavy financial burden placed on individuals may lead to forgoing care for financial reasons, in particular for low-income households. Switzerland has a highly complex healthcare system both in terms of system organization and health insurance. In terms of organization the federal government shares responsibility with the cantons. The latter have considerable freedom in policy design, which generates important differences within the country. This variety makes the Swiss healthcare system an interesting laboratory to study healthcare and health insurance policy. Regarding health insurance individuals have a large set of options to choose from, however this variety may lead to mistakes and suboptimal choice of insurance. The first half of this thesis investigates access to community-based ambulatory care and its association with socioeconomic status in Switzerland. Using routinely collected administrative data, the first chapter shows that access to community-based ambulatory care is not equitable between socioeconomically affluent and deprived regions in Switzerland. These disparities are present at a national level and at a subnational canton, level. The second chapter shows that part of the inequity of access to community-based ambulatory care observed between cantons can be explained with canton healthcare policies such as the regressivity of premium subsidy schemes and the cost of health insurance within cantons. The second half of the thesis focuses on suboptimal health insurance choice as a potential financial barrier of access to care. The third chapter finds that an important share of the population is sub optimally insured, which leads to substantial financial loss for individuals. The fourth chapter finds that the population is divided on its preferences for the introduction of new elements, such as value-based insurance, into health insurance plans. However, the population is united in its dislike of high deductibles. In conclusion, this thesis shows that the variation in healthcare policy between cantons and the complexity of the Swiss health insurance system may lead to inequity of access to community-based ambulatory care as a result of financial barriers of access to care. Difficulties which seem to be unfairly distributed on the less affluent parts of the population. Reforms aimed at making premium subsidy schemes more progressive and homogeneous across the country are likely to improve equity of access to community-based ambulatory care. Reforms aimed at a simplification of the health insurance system, for example by restricting the menu of deductibles, and keeping deductibles low, are likely to improve individual welfare. Finally, the population’s divided preferences on value-based insurance design may inform policy design for future health insurance plans.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».