Equity of access to care and health insurance choice in Switzerland
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".