Peter Neupert
Health Technology Executive

Peter Neupert

Peter Neupert is Microsoft’s corporate vice president for the Health Solutions Group. He led Drugstore.com from 1998 to 2001.

Learning from Singapore, Switzerland

To realize the goals of providing increased access while maintaining fiscal responsibility, we have to dramatically change how we 'do health' today -- whether we're doctors, hospitals, or consumers.

Health is complicated no matter where you go in the world, and there are different challenges in every country. There is no 'best' system anywhere, but there are best practices from around the world worth exploring. Two immediately come to mind:

Singapore's system has characteristics that reflect what we'd expect to see in our own system - personal responsibility, competition and choice. Working people are obliged to put money into a personal savings account for out-of-pocket expenses. The money remains completely in each person's control; each decides how to spend it. And there's choice -- at the Raffles Hospital, one can choose a $1,438 luxury suite with a 24-hour nurse and other amenities OR a $99 a night dormitory room with the six other beds. Procedures cost the same, and are transparent (Publication of the cost of hospital procedures is mandatory, turning the purchase of a hip replacement into something similar to buying a pair of shoes), but there's choice. Contrast this to our system where it's difficult to even get a price in advance, let alone make choices.

Switzerland's system also offers interesting models for consideration -- universal access, individual choice from an array of private insurance options, and a higher level of personal accountability (shared costs by individuals). All citizens are required to buy health insurance and private insurers are required to offer coverage to everyone - regardless of age or any previous medical conditions. Insurers offer a basic package on a not-for-profit basis, and supplemental packages on a for-profit basis that consumers can choose for things like home care, alternative medicine, and so on. Competition is basically about price and service. For those who can't afford the basic package, the government offers direct cash subsidies. In addition, the system provides incentives for consumers to avoid unnecessary treatments by requiring them to share some costs at a higher level than in the U.S. It's not perfect, but it is customer-driven.

In a democratic nation where capitalism flourishes, personal accountability and choice ought to be at the heart of the system.

By Peter Neupert  |  October 22, 2009; 6:54 AM ET  | Category:  Health Care Reform Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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"The system is private and expensive. More expensive than in the US. People choose from a pool of insurance companies and these plans only give 'basic' care. The government program is only for those who cannot pay."

Christina, where do you get this stuff? Look at

http://www.oecd.org/dataoecd/5/34/43800977.pdf which says:

"The United States spent 16% of its national income (GDP) on health in 2007. This is by far the highest share in
the OECD and more than seven percentage points higher than the average of 8.9% in OECD countries. Even
France, Switzerland and Germany, the countries which, apart from the United States, spend the greatest
proportion of national income on health, spent over 5 percentage points of GDP less: respectively 11.0%,
10.8% and 10.4% of their GDP. However, almost all OECD countries, with the exception of the US, and the
middle-income countries, Mexico and Turkey, have full insurance coverage of their population."

In terms of per person medical costs, we spend about 50% more than the Swiss.

Also go to ,say, wikipedia and look up Swiss health care. You will find there are 94 more or less private insurers. While they are all required to offer the same basic policy which they cannot make profit on, they all offer various supplementary policies at extra cost. "The insured pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, then the government gives the insured a cash subsidy to pay for any additional premium"

And so on.

Posted by: lensch | October 23, 2009 8:54 AM
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Peter,

I think you need to clarify more about the swiss system.

First of all, swiss system is neither PUBLIC nor FREE. The system is private and expensive. More expensive than in the US. People choose from a pool of insurance companies and these plans only give 'basic' care. The government program is only for those who cannot pay.

Secondly, premiums are not tied to income. Everybody pays the same, no matter if you make $3000 or $800 a month.

If somebody want "extras" (private room, dental plan, medication not listed in the regular plan, glasses among others) they have to pay a suplemental PRIVATE coverage as well. That is the the insurance companies make money in Switzerland.

Now, I don't know if the swiss system would be a good option but I, personally would be willing to try it over the Canadian, English, and Italian system anytime. But, let's be clear: This plan is not for those who want CHEAP, AFFORDABLE, high quality health care altogether in the same package (meaning: for those who don't want to pay anything and want everything for free and/or make others pay)

Sincerely

Posted by: cristina1999us | October 22, 2009 11:55 PM
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As a Canadian living in the USA, I am grateful to have good insurance in the USA but horrified that my friends don't. I see these problems: use of Emergency services by the uninsured driving up costs, layers upon layers of intermediate folks who contribute nothing to health but facilitate the profit portion, underinsured geting sicker before treating, and obesity contributing to illness. If the energy being used to fight and attack were focussed on solving the insurance/health care crisis, we might be a civilized nation again. How civilized are we to look away from people needing health care or being bankrupted in trying to get it? Where are our values in this issue?

Posted by: jhogg | October 22, 2009 1:37 PM
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You make the Swiss sytem sound as though it is efficient, but the Swiss pay a third more than the French or Canadians and two thirds more than the English per person without any better results in spite of a more affluent pool.

We, of course, pay 50% more than the Swiss with worse outcomes, so I would go for the Swiss system in a NY minute if we couldn't get something better.

Posted by: lensch | October 22, 2009 12:51 PM
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Good food for thought.

I am struck by the idea that the cost of procedures are published in Singapore. If we could pin down costs here we could actually make cost an issue. As it is, we may bemoan the cost problems but we can't address them as individual consumers.

It struck me yesterday that health insurers negotiating rates and setting up networks may be part of the problem with US health care.

Posted by: amelia45 | October 22, 2009 9:45 AM
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