瑞士社会健康保险：同支付--外文翻译.docxVIP

SWISS SOCIAL HEALTHINSURANCE: CO-PAYMENTSWORKSTEFAN FELDER ANDANDREAS WERBLOWFrom the perspective of an insurance community,co-payments are only interesting if they affect total expenditure by a decrease in the probability or the size of damages. If the insured take preventiveactions to reduce the risk or change their behavior when damages occur, their expenditure will decrease. If insurance coverage is comprehensive,important incentives for prevention and restricting damages are absent. Economists speak of moral hazard, referring to the effect of the extent of insurance coverage on the behavior of the insured.In health insurance, the insured have a particularly large influence on the amount of services they demand. Healthy food, sufficient physical motion, prevention of stress, all these reduce the probability of an illness. Moreover, the behavior in case of an illness, i.e.the choice of therapy or the patients’compliance with the physicians’prescriptions will substantially affect health care expenditure. Do copayments reduce moral hazard in health insurance?Swiss social health insurance is an ideal candidate for studying this issue, as co-payments have a long tradition there.Characteristics of the Swiss health insurance systemIn Switzerland, 100 percent of the population is enrolled in the statutory (basic) health insurance system. In the complementary private insurancesector, the equivalence principle holds – the insured pay risk equivalent premiums. By comparison,community rating applies in social health insurance, i.e. every person within a sickness fund pays the same premium irrespective of his/her risk.This implies that the so-called good risks (persons whose payments exceed their expected expendisubsidize the bad risks (persons with payments below the expected expenditure). With thegiven health care expenditure profiles, community rating means for instance that the young subsidize the old and that men subsidize women.In contrast to Germany and other countrie