瑞士社会健康保险：共支付-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 totalexpenditure by a decrease in the probability or thesize of damages. If the insured take preventiveactions to reduce the risk or change their behaviorwhen damages occur, their expenditure willdecrease. If insurance coverage is comprehensive,important incentives for prevention and restrictingdamages are absent. Economists speak of moralhazard, referring to the effect of the extent ofinsurance coverage on the behavior of the insured.In health insurance, the insured have a particularlylarge influence on the amount of services theydemand. Healthy food, sufficient physical motion,prevention of stress, all these reduce the probabilityof an illness. Moreover, the behavior in case ofan illness, i.e. the choice of therapy or thepatients’ compliance with thephysicians’ prescriptions willsubstantially affect health care expenditure. Do copaymentsreduce moral hazard in health insurance? Swiss social health insurance is an ideal candidatefor studying this issue, as co-payments havea long tradition there.Characteristics of the Swiss health insurancesystemIn Switzerland, 100 percent of the population isenrolled in the statutory (basic) health insurancesystem. In the complementary private insurancesector, the equivalence principle holds – theinsured pay risk equivalent premiums. By comparison, community rating applies in social healthinsurance, i.e. every person within a sickness fundpays the same premium irrespective of his/her risk. This implies that the so-called good risks (personswhose payments exceed their expected expend subsidize the bad risks (persons with paymentsbelow the expected expenditure). With thegiven health care expenditure profiles, communityrating means for instance that the young subsidizethe old and that men subsidize women.In contrast to Germany and other countries, Switzerland does n