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
Reinhardt UE. Holes in the Swiss Health Care System—Reply. JAMA. 2005;293(19):2337–2341. doi:10.1001/jama.293.19.2340
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