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Task 3

Name Western Governors University Organizational Systems and Quality Leadership Instructor May 4, 2021

2 Task 3 Country to Compare This is a comparison between healthcare coverage in the United States and Switzerland. Access In 2010, the United States government passed the Affordable Care Act (ACA) that extended affordable healthcare insurance to citizens through employers, the government, and private insurers. When President Barack Obama first enacted ACA, those who were uninsured received a tax penalty when filing an annual tax refund. In 2017, President Donald Trump reversed this action so that citizens were not faced with financial ramifications if they opted out of insurance. Prior to the ACA, dependents were covered under their parent’s insurance until nineteen years of age (Andrews, 2013), but under the new law, both married and unmarried children can remain on their parent’s insurance until they are twenty-six years of age. (U.S. Department of Labor, n.d.). An unemployed person is able to receive government insurance based on income and household size. Medicaid is a government program that assists low-income and disabled adults, pregnant women, and the elderly, and Medicare is a government program specifically for those who are sixty-five and older (HealthCare.gov, n.d.). In 1996, the federal government in Switzerland passed the Health Insurance Law that required universal healthcare coverage to include its low-income citizens (Tikkanen, 2020). Compared to the United States, coverage is mandatory, and all Swiss citizens pay for their own private health insurance. Infants are covered until three months of age, at which time their parents must purchase separate private insurance for them and all children in the household. Retirees sixty-five and older must also continue to pay for private health insurance, and there is

3 no government coverage equivalent to Medicare in Switzerland (InterNations.org, 2020). Citizens who are unemployed are able to file for a government subsidy that is determined by their county after filing their annual tax return (Buswell, 2021). Coverage of Medications In the United States, insurance under the ACA has different tiers that determine the amount of coverage for prescription medications. Each insurance company will have a list of approved medications that will be covered. Citizens are typically required to pay a copay which is a fixed amount due at the time of purchase of the medications, but if their insurance does not cover a particular medication, they will have to pay for it in full (HealthCare.gov, n.d.). Conversely, in Switzerland, citizens pay a flat rate of ten percent of the cost of medications prescribed by their doctors (Expat Focus, 2019). In both countries, non-prescription medications are not covered by insurance and citizens must purchase them in full. Referral to See A Specialist In the United States, for insurance to cover the costs of seeing a specialist, it is required that citizens must first visit their primary care physician to receive a referral (HealthCare.gov, n.d.). In Switzerland, insurance coverage allows citizens to visit specialists without a referral from their primary doctor (Tikkanen, 2020). Coverage for Pre-existing Conditions The ACA does not allow companies to deny a person the right to insurance or increase their rate based on pre-existing conditions such as diabetes, asthma, or cancer (U.S. Department of Health & Human Services, 2017). Switzerland’s government also does not allow for denial of coverage or increased rates based on pre-existing conditions (InterNations.org, 2020).

4 Finance Implications for Healthcare Delivery In the United States, employers are increasing cost-sharing rates or dropping coverage completely due to increasing healthcare costs. As compared to other modern countries, Americans spend double the amount on out-of-pocket medical costs. Caps for private plans can be upwards of $7,900 for an individual and $15,800 for a family. Switzerland’s annual cap is USD $2,645 for an individual and is more regulated by the government (Tikkanen, 2020). Citizens from both countries suffer financial implications regarding healthcare costs. Switzerland has some of the highest medical costs in Europe which leads to lack of utilization of its services. It is not uncommon for Swiss people to pay up front for their medical bills and be reimbursed at a later time by their insurance (Tikkanen, 2020). Uninsured Americans also pay one hundred percent of the cost of visiting the doctor, an acute care facility, or paying for prescriptions. Ultimately, hospitals experience increased costs and usage of resources when treating patients who have delayed their health maintenance due to high healthcare costs.

5 References Andrews, M. (2013, October 1). Young adult insurance quandary: Stay with parents, or go it alone? NBCNews.com. https://www.nbcnews.com/healthmain/young-adult-insurancequandary-stay-parents-or-go-it-alone-8c11300070. Assistant Secretary for Public Affairs (ASPA). (2017, January 31). Pre-Existing Conditions. U.S.

Department of Health & Human Services. https://www.hhs.gov/healthcare/about-theaca/pre-existing-conditions/index.html. Buswell, G. (2021, April 15). Health insurance in Switzerland: a guide for expats. Expatica. https://www.expatica.com/ch/healthcare/healthcare-basics/a-guide-to-swiss-healthinsurance-693473/#:~:text=healthcare%20in%20Switzerland.,Health%20insurance%20for%20the%20unemployed%20and%20low%20earners,reduced %20varies%20across%20the%20cantons. Getting prescription medications. HealthCare.gov. (n.d.). https://www.healthcare.gov/usingmarketplace-coverage/prescription-medications/. Health Care Coverage for Retirees. HealthCare.gov. (n.d.). https://www.healthcare.gov/retirees/. Health Care Coverage Options for Unemployed. HealthCare.gov. (n.d.). https://www.healthcare.gov/unemployed/coverage/. Health Insurance and the Healthcare System in Switzerland Explained. InterNations GO! (2020, September 8). https://www.internations.org/go/moving-toswitzerland/healthcare#:~:text=In%20Switzerland%2C%20everyone%20must%20be,their %20own%20individual%20health%20plan.&text=Expats%20should%20also%20be%20a ware,their%20own%20private%20health%20insurance.

6 Prescriptions In Switzerland: What Is Available And How To Ensure You Get The Right Level Of Care. Expat Focus. (2019, November 4). https://www.expatfocus.com/switzerland/health/prescriptions-in-switzerland-what-isavailable-and-how-to-ensure-you-get-the-right-level-of-care-5761. Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). International Health Care System Profiles: Switzerland. The Commonwealth Fund. https://www.commonwealthfund.org/international-health-policycenter/countries/switzerland. U.S. Department of Labor. (n.d.). Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Businesses and Families FAQs. Employee Benefits Security Administration. https://www.dol.gov/agencies/ebsa/about-ebsa/ouractivities/resource-center/faqs/young-adult-and-aca#:~:text=to%20age%2026%3F,The%20Affordable%20Care%20Act%20requires%20plans%20and%20issuers%20that%2 0offer,and%20to%20all%20employer%20plans....