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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.293.19.2339-b

To the Editor: Drs Herzlinger and Parsa-Parsi attempt to account for apparently better health care in Switzerland than in the United States despite approximately one third less expenditure per capita.1 They seek an explanation in the function of the insurance system. Examination of their data, however, raises a question of the actual cost of individual services provided. The Swiss have a higher rate of inpatient admissions with a substantially longer length of inpatient stay. They also have more practicing physicians and more pieces of expensive equipment per population unit. Although utilization rates for that equipment are not specified and the use of pharmaceuticals and their costs are not addressed, the only thing that appears to be less utilized in Switzerland than in the United States is physician visits. Given the higher number of inpatient days per population unit, a substantial part of the savings may be from a lower relative cost of providing individual elements of care, especially inpatient care, rather than from a more efficient delivery system.