Healthcare-Switzerland

I was doing my PhD in physics in Basel, Switzerland from 2020 to 2021. The period was when Covid just raged in Switzerland. Myriads are reasons that I quit my PhD, healthcare system was surely a big role.

First, the compulsory insurance was too expensive that caused my anxiety disorder even greater. Second, I was sexually harassed by a medical doctor and I found no governmental organisation to take care of this. Two years later as of now, I found that there was still no governmental organization taking care of patients being sexually harassed by medical doctors, although this issue was discussed some 20 years ago. https://www.swissinfo.ch/eng/doctors-clamp-down-on-sexual-abuse-of-patients/3750036

So let’s examine what Swiss government’s role is in this health care scheme, what healthcare goal does the Swiss government take? Does it meet its goal in an eye of an end user? If not, where might the problems be?

Principles of Healthcare in Switzerland

Is healthcare a responsibility for the states or individual’s right in Switzerland?

The Governmental role in Switzerland is both Swissmedic and FOPH — — Swissmedic handles marketing approval and the Federal Office of Public Health (FOPH) deals with reimbursement and pricing. The FOPH stated that,

The compulsory basic insurance scheme system is based upon the principles of equality and solidarity, in that it aims to grant every insured person the same unconditional rights regarding health care.

we can see that Swiss regulations clearly contained both — — equality such that States being endows people the right to have access to healthcare, and solidarity such that individuals being responsible and take care of their own health. The underlying principle for a high deductible was understandable from the standpoint of strengthening the equity principle, to increase one’s own consciousness towards his/her own health. One way to achieve this end is to encourage higher deductibles that are supposed to “encourage moderation in their use of health care services” (Eberhard, 2000, p. 331).

In 2021, over 70% of the Swiss population opt for the minimum deductible.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555474/) The consistently rising costs of the premiums for basic insurance have impoverished many beneficiaries and have had a significant impact on the purchasing power of the lower class (Despland, 1990). Members of middle class have also been strongly affected, as they are not entitled to subsidies from the government for the payment of premiums, which only low-income citizens are granted.

Two referendums were held in Switzerland on ‘making healthcare more affordable’. A referendum measure entitled “Health at an affordable price,” for example, proposed to make health insurance premiums proportional to income, and at the same time, the referendum sought to control health care expenditures without pauperizing the lower and middle classes. The proposal was rejected in May 2003. Another equality-based referendum in 2007 proposed a tax-financed, government-run health care agency, which was also rejected by the population.

So it is the Swiss citizens’ own choice to keep a healthcare system, in my eye, accessible but unaffordable. The Swiss pharmaceutical system was, on the other hand, impressive — — pharmacists can temporarily prescribe medications to clients/patients, and that Basel is the hometown to Roche and many other international pharmaceutical firms. This means there was no international market entry trading issues for Swiss medications inside Switzerland. The pharmaceutical price in Switzerland was using formal reference pricing in combination with value-based pricing (“national therapeutic comparison”). The average price of pharmaceuticals in nine countries,Belgium, Finland, Sweden, Denmark, the Netherlands, France, Germany, the UK and Austria is used as reference. This lead to the Swiss medical price almost the same as in Germany.

https://www.swissinfo.ch/eng/doctors-clamp-down-on-sexual-abuse-of-patients/3750036

How easy was it to go to doctors in Switzerland?

Within three months of arrival one was asked by law to register in the healthcare system. In order to resume my psychological medication for long term insomnia, I had to visit doctors for Bromazepam(sleeping pills), Duloxetine(antidepressant) and tranquilizers.

I had to choose a subscription from private insurers that met my needs to regularly visit the psychiatrists the most.

Two choices:

Option one, if I choose the cheapest monthly subscription 350 CHF with the highest deductible of 2500 CHF within a year. After that would I start to be reimbursed — — up to 90%. So if I go to a psychiatrist twice a month and get prescribed, on top of the monthly medical insurance of 350 CHF, I pay each time 250 CHF for the consultation hour plus 60 CHF medications. These amount to 970 CHF per month. Afterwards I could be reimbursed, so I would pay 412 CHF per month from the fourth month in Switzerland.

Option two, the most expensive monthly subscription, which was 550 CHF, the annual deductible was 300 CHF. So if I go to a psychiatrist twice a month and get prescribed, I would pay 550+2502+602=1170 CHF for the first month. And from the second month I could get reimbursed, which meant I paid monthly fee of 550 CHF plus 10% of psychiatric medical fees — — in total 612 CHF per month afterwards.

The above listed medical fees are MINIMUM in that I was not sick or I didn’t have accident.

My monthly net salary after tax was 3244 CHF. The health insurance was hardly affordable for me. Accessible it is in Switzerland to go see a doctor compared to Germany, but having an appointment with an orthopedie or specialists still takes time— — in a week or more. Affordable it was not — — paradoxical as it seemed, psychiatrist consultations calmed me down from the toxic working environment, but it was also the medical bills that drove me more and more anxious.

But let’s look at other bills as well — — my apartment was 1050 CHF per month, food and utilities 300 CHF, public transportation 120 CHF. With the Option 1 Scenario, what was left after the beginning of the month was 804 CHF. Option 2? 604 CHF. I am not yet taking into account the housing deposit, which was 3 months of my rent — -3150 CHF.

As of 2021, Basel-Stadt started to regulate minimum wage to 21 CHF per hour. With 21 CHF per hour equalizing a full-time position of 40 hours per 20 days a month, it will be 3360 CHF before tax. After tax the minimum monthly wage would be around 2812 CHF. And mine was 3244 CHF. That was not a big difference with 432 CHF.

If these low-incomers happen to have mental issues or other diseases, how could they afford medical treatment? They have low-income deductions automatically issued from the Canton’s office to make sure they have full access to the Swiss health care.

And close-to-low-income PhD students? No chance.

I applied for health-care waivers but didn’t get approved.

Look at the figures I experienced. I couldn’t afford health care, hence I left Switzerland. But Switzerland is a land that relies very much on expatriate researchers, over 50% of the PhD candidates are from abroad. If the FOPH do not secure the expatriate researchers by both an affordable good health care and qualified doctors with working ethics — — — -in the post-pandemic times where health becomes increasingly critical, Switzerland could lose its competitive academia workforce greatly. I am just saying.

What more could be done?

• include PhD students’ in a low-income waiver system, or at least they wouldn’t be freaked out because of medical bills — -and provide mandatory psychological scheme that includes mental health consultation
• establish an anonymous sexual harassment organization in charge by the State Government for the patients to report sexual harassment cases and make sure patients’ security. It’s about time to look at the fact that ‘yes, sexual harassment is happening. What can we do now?’ One preventative solution might be that patients can choose that a nurse is present when doctors perform examination.
• fix the health-care system rate such that it is in proportional to the person’s income
• Establish central data collection such that patients’ data could be viewed by doctors and a proper treatment according to the trajectory could be made