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May 18, 2005

Holes in the Swiss Health Care System

Author Affiliations

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

JAMA. 2005;293(19):2337-2341. doi:10.1001/jama.293.19.2338-a

To the Editor: The Special Communication by Drs Herzlinger and Parsa-Parsi1 describes the comparative expenditures, resources, and some clinical outcomes for the medical systems in Switzerland and the United States, as well as selected states that have demographic features that most resemble the Swiss population. Key differences include far greater spending in the United States (per capita, as percentage of income, and as percentage of gross domestic product), with fewer resources in some areas (acute care beds, practicing physicians, computed tomography scanners, magnetic resonance imaging units, and occupied inpatient beds). Important health outcomes were worse in the United States compared with Switzerland (eg, infant mortality was 26% higher in 1999 and mortality from cerebrovascular disease was 43% higher in 1997). Dr Reinhardt, in his Commentary,2 notes that in 2000 the rate of avoidable premature deaths in the United States was 5120 per 100 000 compared with 3400 per 100 000 in Switzerland, a relative excess of 51%.