Abstract
Little is known about doctors' opinions on how to finance health services. In Switzerland, mandatory basic health insurance currently uses regional flat fees that are unrelated to health and ability to pay, and optional complementary insurance uses risk-based premiums. Our objective was to assess Swiss physicians' opinions on what should determine health insurance premiums. We surveyed doctors in the canton of Geneva, Switzerland, about the desirable funding mechanism for mandatory health insurance and complementary health insurance. The proposed determinants of insurance premiums were current health and past medical history, lifestyle, healthcare costs in the previous year, genetic susceptibility to disease, regional average healthcare costs, household income, and wealth and demographic characteristics. Among the 1,516 respondents, only a few (<5%) believed that the mandatory health insurance premium should depend on health risk (health status, previous costs, genetics, and age and sex). More than 30% of respondents supported premiums based on lifestyle (34.6%), regional average health expenditures (31.2%), and household income and wealth (39.6%). For complementary health insurance, most respondents supported premiums based on lifestyle (74.6%) and on health risk (46.4%), but surprisingly also on household income and wealth (44.9%) and regional average health expenditures (39.4%). The characteristic most influencing the answers was the medical specialty. Doctors' opinions about healthcare financing mechanisms varied considerably, for both mandatory and complementary health insurance. Lifestyle was a surprisingly frequent choice, even though this criterion is not currently used in Switzerland. Ability to pay was not supported by the majority.
Highlights
How health expenditures should be financed is a matter of debate
In Switzerland, mandatory basic health insurance currently uses regional flat fees that are unrelated to health and ability to pay, and optional complementary insurance uses risk-based premiums
Among the 1,516 respondents, only a few (
Summary
How health expenditures should be financed is a matter of debate. In most developed countries, healthcare financing is a mix of tax funding (Beveridge model), social insurance funding (Bismarck model), private health insurance and direct out-of-pocket payments. Individual contributions to social health services are linked to ability to pay, either through taxation funding, where the income tax component is typically progressive with income, or through social health insurance funding (or mandatory insurance funding), which is usually financed jointly by employers and employees through payroll deduction. Such systems enforce solidarity between the rich and the poor. Low-income residents receive subsidies to pay their health insurance premiums, which makes premiums income-dependent at the lower end of the income spectrum
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