Regina Herzlinger of Harvard University is one of the more visible academic supporters of consumerism in health care. She’s also wrong a good bit of the time, not in her statements of fact, but rather in her conclusions about what the facts ‘mean’.
Take, for example, Dr. H’s observations in the WSJ(sub req) (11/19/07) about the Swiss health care system. She notes that individuals have a lot of financial skin in the game as they pay 65% of their premiums. Dr. H then demonstrates her acrobatic verbal athleticism by leaping over a rather broad logical chasm to a conclusion that is not supported by the facts; to wit, because the Swiss pay a lot out of their own pockets, health care costs in Switzerland are lower, and increasing at a lower rate, than here in the US.
Fortunately, Maggie Mahar has seen fit to carefully analyze the Swiss insurance and health care systems, and her efforts blow away Herzlinger’s sloppy work.
Maggie’s net is simple – rather than individual consumerism at work, Swiss success is built on careful, consistent, intelligently designed (no pun intended) and rather comprehensive regulation of insurance and health care.
Nov
20
Hmmm…I suspect the relative success of the Swiss approach can be at least partly attributed to consumerism. No doubt there is considerable bias in the analysis on both sides. So, the battle continues.
Then again, if there is agreement that the Swiss approach is more efficient and effective at delivering health care to citizens, it would seem preferable to focus on how the transition was implemented, looking for lessons learned and aspects that differentiate. If we agree that the results are superior, give credit (political cover) to both sides as to the drivers of the results and move forward designing a solution that emulates and improves upon an established and acknowledged successful system.
I have had two encounters with the Swiss in the past several years. All were at Zurich airport.
An airport is not health care, but it is an institution with rules and processes.
I missed a flight because my flight from Spain was late. Luckily I had a “Premier” airline card and could stand in the shorter customer service line. The clerk got us re-booked, but it was slow going. He filled out, in legible handwriting every single form in triplicate. I don’t know what those in the non-premier line did, but I’m guessing some had an overnight stay in Zurich.
Going through security they noticed something in my carry-on that no one in Barcelona noticed. My entire carry-on was searched with painstaking completeness.
At the gate I was interviewed as the purpose of my trip, and asked to describe my luggage and anything that might be of interest to security in it.
My guess is that if the Swiss decide that health care is costing too much that no detail is left un-examined. I would wonder how the speed and timeliness of care goes in Switzerland, and whether physicians operate by strict treatment guidelines, or have the latitude to innovate.
I also wonder how the Swiss handle the health care of their “guest workers.” Many European countries have numbers of workers from poor countries working there doing things the natives don’t do. Are they included in this system?
Jim, on what do you base this suspicion that consumerism has something to do with Swiss success? Is it anything about the Swiss system, or just a general feeling that consumerism must be behind a health care system that successfully solves the cost/quality/access equation?
The only element of consumerism I see in the Swiss system is the choice of many insurers. But there is limited differentiation of products (less than in the US). Most importantly, there is limited cost sharing in the place where the consumer-directed movement says it should be: at the point of care. Instead, most of the cost-sharing occurs at the payment of premium. That’s exactly the wrong place to put it if the goal is to reduce unnecessary utilization and encourage price comparison.
What I’d most like to see is an analysis of how 80 insurers survive in a place as small as Switzerland, and what they do to differentiate themselves from competitors.