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May 18, 2005

Holes in the Swiss Health Care System—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(19):2337-2341. doi:10.1001/jama.293.19.2340

In Reply: None of the letters responding to my Commentary on the Swiss health system take me to task, other than wondering why anyone would view the second most expensive health system in the world as a role model. To US citizens, the appeal of the Swiss system is that it has fewer resource constraints than that of the country with the third most expensive health system in the world, Canada.

Dr Relman agrees that the Swiss health system is, in essence, managed competition among private health insurers clipped onto a tightly regulated health care delivery system. That pluralistic insurance system is apt to absorb a higher fraction of total health spending for administration than do single-payer systems such as Canada’s provincial health plans, the US Medicare system, or Taiwan’s single-payer national health insurance system.1 However, the Swiss system is unlikely to absorb anything like the huge fraction of health spending burned up by the inchoate, highly fragmented US health insurance system.

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