SUISSE news Summer 2017
Health | Switzerland-Canada Comparisons
July 2017

Health Care Systems in Canada and in Switzerland

(Kurt Schläpfer)
In Switzerland health care is privatized, and a family with two children can easily spend CHF 1,000 per month for a basic health insurance plan. In Canada health care is publicly funded, meaning that the government pays for the health costs. How do the two health insurance systems compare to each other?

Health care system in Canada

Public health care is governed by the Canada Health Act. It is designed to ensure that all eligible people in the country have reasonable access to insured health services without direct charges. (For newly immigrated people, the qualifying period for the free access is 6 months.) But the free coverage of health services is limited. What is covered in full are physician visits and ward accommodations in hospitals, whereas prescription drugs are not paid for. Supplemental health insurance is possible either through your employer or through a policy you have to buy yourself. If you want a private room in a hospital and you have no extended health coverage, the extra charge can also be paid out of pocket.

The Washington Examiner writes in an article of June 5, 2009:
“Canadians face some of the longest lines for access to the advanced technologies essential to most major surgeries. (…) Once a Canadian patient finally makes it into the examination or operating room, there’s a good chance that his doctor is using antiquated equipment.” 

Health care system in Switzerland

According to the Federal Health Insurance Act, every person living in Switzerland is obligated to pay for a basic insurance plan covering the costs of medical treatment (including medication prescribed by a doctor) and hospitalisation, but excluding dental treatment. Although the coverage of treatment is the same throughout Switzerland, the insurance premiums vary according to insurance company and place of residence. In addition to the premium, you are obligated to pay a deductible. (This is the amount of expenses that must be paid out of pocket before the insurer will cover any expenses.) Moreover, you pay 10% of the costs of treatment up to a maximum of CHF 700. The mandatory insurance can be supplemented by a complementary insurance policy, for instance to obtain a private room in case of hospitalisation. 

Three examples how the health care systems work

1) You move with your family and children to another city and need a new family doctor. 

In Switzerland you phone a local doctor (which you may find in the telephone directory) and you can see him as soon as you need him.

In Canada the wait time until you get a family doctor can exceed one year. In the meantime, the only alternative is the hospital emergency department. (A research poll commissioned 2007 by the College of Family Physicians of Canada says that more than two million Canadians have tried to find a family doctor and were not successful.)

2) You get sick on the weekend and want to see a doctor. 

In Switzerland you call your family doctor who will most probably come to see you at home or give you advice by phone. 

In Canada you have two options: Either you wait until Monday when your family doctor can see you during regular office hours, or you go to the nearest hospital emergency department. (In some health care plans you have free access to a telephone health advisory service, where a nurse will provide you with advice.) 

3) You need a simple blood test for checking your INR level (the degree of blood thinning). 

In Switzerland you go to your family doctor who takes a drop of blood from the finger. Using a special device, the doctor can immediately read the INR level and discusses the result with you. This visit to the doctor may take less than 15 minutes.

In Canada you need a requisition from your family doctor in order to go to a blood laboratory. The waiting time before your blood is taken can easily exceed 45 minutes. The result of the blood test is sent back to your doctor, which typically takes 2-3 days. In order to find out the results from the doctor, you need to schedule another appointment. 

Health care systems in Canada and in Switzerland

 

Canada

Switzerland

Physicians density per 100,000 inhabitants (2007)

218

385

Health insurance for basic coverage

Paid by the government

Private health insurance mandatory for all residents

Supplementary health insurance

Subsidized by the government and usually obtained through employment

Supplementary insurance for different plans available; purchased by approx. 80% of the population


Four questions to a Swiss physician in Canada

Katrin Scheinemann works as a staff physician/assistant professor in pediatric hematology and oncology at McMaster Children's Hospital in Hamilton. She completed her pediatric residency in Aarau, Muensterlingen and St. Gallen, Switzerland, and her fellowship at the Hospital for Sick Children in Toronto.

Question: You are familiar with the health care systems in Switzerland and in Canada. What are the major differences from a viewpoint of a medical doctor?

I can only comment on the setting in a pediatric hospital. Compared to Switzerland there are more physicians sharing the work and better coverage. There is protected time – in an academic setting – for teaching and research. Medical school and the training of residents are completely different from Switzerland – much more practical for the learner and it involves much more teaching and supervision. The whole system is much less hierarchical compared to Switzerland and much more multidisciplinary – from my point of view clearly to the advantage of the patients. Due to different insurance system coverage of prescribed drugs becomes an important issue of the daily work and needs lots of investigations and work up.

Question: How do the salaries in the two countries compare?

For me – coming as a trained pediatrician – the salaries for residents and fellows are significantly lower than in Switzerland plus you are paying more taxes. Then as a staff physician the salary here is much higher. The salaries for allied health workers here are varying significantly based on unionized or non-union hospitals. This makes the comparison quite difficult.

Question: There are many complaints in Canada about the wait time in hospitals for services not falling in the category of urgent need. What is your experience? 

As I am working in the field of cancer in children which involves often urgent care there is no difference in waiting time compared to Switzerland.

Question: Which health care system is more favourable 

…from the viewpoint of the doctor?

The system in Canada clearly supports young physicians starting their academic career compared to back home. Long term contracts are standard. Protected time for research and teaching unspoken. Research money/ grants are better available.

…from the viewpoint of the patient?

For my patients there is no difference. Personally it took me some time to find a family physician; appointments are often not available the same week.                
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