Running head: US VERSUS SWITZERLANDS HEALTHCARE

United States versus Switzerlands Healthcare System

Salena Barnes, RN
Georgia College and State University

US VERSUS SWITZERLANDS HEALTHCARE

Abstract
After decades of debate, a flawless healthcare system has yet to be designed. However, through
many trials and errors, some countries are a closer to providing accessible, affordable, and
quality healthcare to the vast majority. This paper will discuss the different ways in which the
US and Switzerland achieve universal coverage, the costs associated with each, and the costs or
benefits of each system for patients, professionals, and organizations. To begin, both healthcare
systems aspire to provide universal healthcare insurance to its citizens. In addition, both
healthcare systems aim to provide access to healthcare via insurance coverage through an
insurance market. Government regulation and oversight play a major role in cost containment in
Switzerlands healthcare system. Whereas, in the US, a free market in the private sector and a
government funded public sector have driven costs to one of the highest in the world. The
Patient Protection and Affordable Care Act (ACA), is a step toward controlling costs, spending,
and providing affordable healthcare to all Americans.
Keywords: United States Healthcare, Switzerland Healthcare, the Patient Protection and
Affordable Care Act

US VERSUS SWITZERLANDS HEALTHCARE

A Comparison: United States versus Switzerland Healthcare System

Access, affordability, and quality of healthcare services have traditionally been reserved
for those that can afford the premiums, as opposed to the reality that all people need access to
quality healthcare services. Within this undercurrent, there is a moral concept that social justice
to humankind will continue to be discriminatory to the likes of illness, racial, and gender
discrimination unless there is a paradigm of equal access to healthcare services made available to
all persons. The countries of Switzerland and the US have implemented healthcare reform
policies that have changed the landscape of healthcare for both uninsured and insured citizens.
These policies where enacted to provide universal healthcare service, which establish a fair
competitive market between health insurance companies. The costs and benefits to all
participants in these healthcare systems will be discussed.
Status of the US Healthcare System
Located in the Northern Continent, the US is one of the powerhouses of the world and a
nation where democracy and hope is alive and well. However, for a nation that offers true
democracy struggles in equality in its healthcare system is a concern for everyone. Due to
socioeconomic status, many Americans do not have health insurance (Reid, 2013). This is a
vulnerable population, composed of the large number of low-income middle-income citizens that
chose not to obtain health insurance. In addition, these citizens were not covered under another
form the US offers known as Medicaid. Medicaid is governed by individual states within the US
and these states have the discretion to set a mean to determine what percentage of the population
should have access to Medicaid. A case in point, in the state of Mississippi, if a person makes
over $8,200 a year, that person is ineligible for Medicaid (Reid, 2013). However, the states of
Texas and Louisiana has an income ceiling of $5,000 a year, which would qualify a person for

US VERSUS SWITZERLANDS HEALTHCARE

Medicaid. Medicaid was intended to aligned the uneven access enigmas of the disadvantaged
class for access to health care services (Reid, 2013). However, the fiduciary means are regulated
by meeting federal eligibility requirements and other individual state prerequisites. Aside from
the covered American citizens, there are three groups of American citizens not covered under any
form of healthcare coverage. According to Reid (2013), these non-covered citizens are adults not
covered through an employer, unemployed, and self-employed. In addition to this vulnerable
group are the low-income families whose threshold income will not qualify them for Medicaid
and adult children not covered under Medicaid. Essentially, this group had to find healthcare
insurance coverage on their own.
Moreover, in 2013 there was an estimated 64% (54% employer-based insurance and 11%
acquired directly) of the US residents receiving health insurance coverage from private voluntary
health insurance. Medicare provided coverage for 16%, Medicaid 17%, and the military 5% of
the population. However, there remained 42 million uninsured individuals in the US. The ACA
required that all Americans have health insurance and offered subsidized premiums to lower and
middle class families. The decision of Medicaid expansion was left in the hands of the states,
which essentially would expand the coverage for low-income families. The implementation of
the ACA is estimated to decrease the number of uninsured by 26 million by 2017 (HHS, 2014a).
Yet, some public programs provide coverage to overlapping populations. For instance in
2010, approximately 9.6 million Americans qualified for both Medicare and Medicaid. Another
example is the Childrens Health Insurance Program (CHIP), which is a federal-state program
that provides coverage for children to low income families in some states as an extension of
Medicaid or as a separate program in other states. CHIP covered over 5.7 million children in
2013. Forty-six states and the District of Columbia covered children at or above 200% of

US VERSUS SWITZERLANDS HEALTHCARE

Federal Poverty Level and twenty-four states covered children with family incomes 250% of the
Federal Poverty Level. States have the option of getting the CHIP match for coverage up to
300% of the Federal Poverty Level, thus being higher than Medicaid federal funding matching
rate. States that extend coverage greater than 300% of the Federal Poverty Level can obtain the
Medicaid matching rate (HHS, 2014a).
Medicare is a health insurance program provided to Americans 65 or older, individuals
under the age 65 with certain medical disabilities, and persons of all age with End State Renal
Disease, which requires kidney transplant or dialysis (CMS.gov, 2015). Medicare has Part A
(Hospital Insurance), Part B (Medical Insurance), and has prescription drug coverage. In 2006,
Medicare prescription drug coverage was available to all Medicare recipients (CMS.gov, 2015)
In 2010, the US introduced the ACA, which was formed to establish coexisting
responsibility amongst the government, employers, as well as individuals for making certain that
all Americans have access to affordable, quality healthcare insurance (The Commonwealth Fund,
2015). According toThe Commonwealth Fund (2015), Americas disparity issue among the
insured and uninsured have been a problem for decades and this act attempts to reduce these
disparities. Government run facilities known as Federal Qualified Health Centers provide
primary and preventive care for citizens, regardless of their inabilities to pay. In addition, the
ACA will improve equality for mental health, substance abuse services, and provide
supplemental funds to community centers in underprivileged neighborhoods (The
Commonwealth Fund, 2015).
The ACA also aimed to address the high number of the underinsured citizens within the
lower and middle classes (Reid, 2013). The ultimate goal is to produce quality care for everyone
with exceptional patient satisfaction (Daley & Gubb, 2013). The ACA established a government

US VERSUS SWITZERLANDS HEALTHCARE

controlled exchanges of the private sectors insurance plans (Reid, 2013). These exchanges were
created to provide and produce affordability through competition and subsidies. To begin, the
government will monitor regulations of the insurance companies, hoping to keep integrity among
the companies. In addition, the government will provide subsidies to individuals with incomes
that are lower than 100% to 400% of the countrys poverty level. Keeping in mind, the subsidies
are based on income (Reid, 2013). Through the exchanges, insurance companies must offer
qualified health plans with cost sharing restrictions and provide other health benefits such as
preventive care, emergency room services, and hospitalization (The Commonwealth Fund,
2015).
As of 2014, consumers are protected from discrimination due to pre-existing conditions,
annual limits on insurance coverage, and ensured coverage for when participating in clinical
trials. The goal is to improve quality and lower cost by making care more affordable,
establishing the Health Insurance Marketplace and increasing the small business tax credit (HHS,
2014a).This tax credit allowed qualifying businesses a credit up to 50% of their contribution
towards providing employee health insurance and a 35% credit for small non-profit organizations
(HHS, 2014a)
Additionally, tax credits were given to the middle class to aid with affordability of
insurance with incomes between 100% and 400% of the poverty line that are ineligible for other
types of coverage (HHS, 2014b). This tax credit can be provided in advance which aides in
lowering the premium payments each month instead of waiting for tax time. Furthermore, the
tax credit is refundable to moderate-income families, as well as qualifies them for reduced cost
sharing (HHS, 2014b).

US VERSUS SWITZERLANDS HEALTHCARE

During the year 2011, the US healthcare system employed 15.7% of the workforce, with
an overhead of $2.7 trillion, doubling up since 1980 as a percentage of US gross domestic
product (GDP) to 17.9% (Moses et al., 2013). However, since 2000, price particularly of
hospital charges (+4.2%/y), professional services (3.6%/y), drugs & devices (+4.0%/y), &
administrative costs (+5.6%/y)), not demand for services or aging of the population, generated
ninety-one percent of cost increases; personal out-of-pocket costs on insurance premiums and copayments have declined from twenty-three percent to eleven percent. Furthermore, chronic
illnesses account for 84% of the overall costs amongst the entire population, not just the elderly.
Three aspects have produced the most change. The first being consolidation, secondly
information technology, and last the patient as consumer. (Moses et al., 2013).
Moreover, the health of the population and the life expectancy at birth in the US has
improved from 1990 to 2010 ("The state of US health, 1990-2010: Burden of diseases, injuries,
and risk factors," 2013). However, improvements in health of the US population have not kept a
pace with other industrialized nations. Nonetheless, morbidity as well as chronic disability
currently account for almost half of the US health problem. In addition US has not been abreast
with development of improvements with the overall populations health, yet spends the greatest
per capita on healthcare amongst all other countries ("The state of US health, 1990-2010: Burden
of diseases, injuries, and risk factors," 2013).
The Status of Switzerlands Healthcare System
Switzerland, located in Western Europe is considered a small country with a population
of 7.8 million living on total area consisting of but no greater than 41,000 km2 (Camenzind,
2012). Switzerland is a wealthy nation that is home to the World Bank which has Switzerland in
front the America based on income equality (Reid, 2013). Within the geography of Switzerland,

US VERSUS SWITZERLANDS HEALTHCARE

there are twenty-six cantons, which have varying differences of population, socio-economics
situation, and differences of languages. The Switzerland government is divided into three levels
of government, twenty-six cantons, and roughly twenty-six hundred different municipalities.
These three levels of government also have a say in the Switzerland healthcare system that is
normally levied by a system of regulated competition (Camenzind, 2012).
Universal healthcare came into effect around 1996 as having full coverage in basic health
insurance (Daley & Gubb, 2013) Initially Switzerlands healthcare system was covered by
statutory health insurance (Daley & Gubb, 2013). However, government introduced a basic
package. This basic package has restrictions to medical treatments that seemed appropriate,
medically, and cost effective. The basic package allows some competition between insurers,
which will drive up standards and reduce insurance premiums. This basic package prohibits
discrimination and mandates that the insurance companies must accept all applicants during open
enrollment and the insurance companies may not see-saw the premiums based on pre-existing
conditions, age, or health history. One major restriction in the basic package is that individuals
must seek and receive treatment only in the canton in which they live. Further, they cannot be
treated in unaccredited facilities, in order for the provider to receive payments. This package is
divided into three categories: Sickness, Maternity, and Accident (Daley & Gubb, 2013). Listed
below is an itemized treatment guide which is covered under the basic package (Daley & Gubb,
2013).
Sickness
Hospital Stay
Outpatient Care
Treatments/Examination
Physiotherapy
Ergotherapy
Complementary Medicines

Maternity
Legal Abortion
Post-natal exams
Childbirth Consultations
Breast-feeding Consultations
Routine Examinations

Accident
Rehabilitation
Emergency Treatment
50 % of Transportation Costs
Serious Dental Treatment
Spectacles and Contact Lens

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Within this basic package are provisions that will ensure vulnerable populations have
access and receive quality healthcare services. According to Daley & Gubb (2013), it is
mandatory that all individuals purchase a basic package or they receive a penalty. For the
financially challenged, the individual cantons are responsible to offer tax-financed subsidies
directly to them so that they are able to make the necessary purchase.
However, an established healthcare system that steadily provides higher quality and
lower healthcare costs than in other comparable countries does not yet exist. Regulated
competition results in large disparities in healthcare usages and costs that are associated with
different geographical areas. Consumption and cost containment strategies should contain
several element, such as supply, demand, and financing. Significant effects in regulated
competition has been noted in the structure of the Swiss regional healthcare system (Camenzind,
2012; Crivelli & Salari, 2014).
In addition, socioeconomic status tends to effect access to healthcare. To assess the effect
of socioeconomic status, Rey, Faouzi, Huchmand-Zadeh, and Michel (2011) examined the
incidence of stroke, risk factors and outcome, as well as its influence on the severity of an acute
stroke, stroke mechanisms, and acute recanalization treatment in Switzerland. Included in the
study were 1,062 consecutive acute ischemic stroke patients. The study found improved
outcomes at seven days and at three months in the patients with a higher socioeconomic status in
an acute stroke population despite the patient receiving identical care. However, both
populations were similar in age, cardiovascular risk factors and preventive medications.
Moreover, the study considered insurance as a marker for socioeconomic status without
collecting data such as income or education level (Rey et al., 2011).

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In addition to inequities in cost and disparities, chronic disease management remains an

issue in Switzerland. A qualitative study done by Lauvergeon, Burnand, and PeytremannBridevaux (2012), revealed at each level, stakeholders share common opinions towards the
feasibility of chronic disease management in Switzerland. The main barrier was linked to the
federalist political organization as well as to financing such programs. In addition, the
participants foresee difficulties to motivate both patients and healthcare professionals to
participate. However, they have favorable attitudes concerning chronic disease management
(CDM) and are convinced that Switzerland possesses the financial, structural, and human
resources to develop necessary programs (Lauvergeon et al., 2012).
Moreover, diabetes mellitus is a common chronic disease that affects millions of
individuals globally. A study to assess the quality of care provided to individuals with diabetes
mellitus type 1 or 2 in Canton of Vaud, Switzerland revealed the mean age was 64.4 years (59%
were men) (Peytremann-Bridevaux, Bordet, & Burnand, 2013). There were 18.2% type 1 and
68.5% type 2 diabetes individuals; however, the diabetes type remained undetermined for nearly
20% of patients. Fifty percent of the individual were administered oral anti-diabetic drugs,
twenty-three percent insulin, and twenty-seven percent both. Of the two-hundred nineteen
HbA1C-aware patients, 98% reported one HbA1C check during the last year. In addition,
94% reported one blood pressure measurement, one weight measurement or lipid test, and
approximately 68%, 64% and 56% had feet examination, microalbuminuria check and eye
assessment. Diabetes-specific risk screenings, influenza immunization, physical activity as well
as dietary recommendations were not often reported. Essentially, there is room for diabetes care
improvement in Switzerland (Peytremann-Bridevaux et al., 2013).

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The Quandary
Jost (2012) recalls the history of attempts at cost control in the US which traces back to
the origins of our modern healthcare financing system in the 1930s- 1940s, over healthcare cost
regulation in the 1970s, as well as the deregulation in 1980s-1990s, to the current ACA (Jost,
2012). The US has been unsuccessful at controlling healthcare cost over a long period of time
(Jost, 2012). There have been times in the 1970s and 1980s when healthcare costs were stable or
even decreased in reaction to policy initiatives. By the 1990s increases in private sector
healthcare cost slowed down due to discipline of managed care, whereas Medicare costs
decreased by the end of the decade as a result of tighter payment managements (Jost, 2012).
Moreover, the rise in cost in the US has been above the level of inflation continuously for
the past half century (Jost, 2012). Additionally, private health insurance premiums growth
declined during the past decade, premiums increased by seventy-eight percent from 2000 to
2007, and a seventeen percent increase in the consumer index, as well as a nineteen percent
increase in the workers wages for the same period. Healthcare costs have been unsuccessfully
controlled by the market and regulatory strategies (Jost, 2012).
There have been problems controlling the cost associated with public programs such as
Medicaid and Medicare (Jost, 2012). Such programs do not have a fixed budget and tend to pay
providers for whatever medical services provided. Efforts to control costs or limit coverage are
routinely stifled by tenacious provider lobbying. A total of $543 million was spent on lobbying
in 2009, which is more extensive than any other industry (Jost, 2012).
Switzerland relies on private insurers for coverage, however, there is substantial
government intervention to restrict healthcare costs (Jost, 2012). Current estimates indicate the
annual growth in national healthcare expenditures will increase by only one percent due to the

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ACA from 2010-2020. However, expenditure growth will surpass overall inflation and the
economic growth, totaling 5.8% per year. The solution to healthcare cost containment remains
elusive (Jost, 2012).
Moreover, US healthcare providers sector raised 3.8% in 2013 with a value of $2,908.5
billion dollars ("Health care providers industry profile: United States," 2014). By the year 2018,
the US healthcare providers sector is estimated to have the value of $3,880.8 billion dollars,
which is an increase of 33.4% from 2013. One of the largest portions in the US healthcare
providers sectors is outpatient care, which accounts for 49.2% of the sectors total value.
Furthermore, the US accounts for 40.7% of the international healthcare providers sector value
("Health care providers industry profile: United States," 2014).
Furthermore, the Organization for Economic Co-operation and Development (OECD)
figures propose that 65.2 percent of health spending in the Swiss population is public, below the
OECD average of 72.2 percent, and substantially below the United Kingdom (UK) figures
(Daley & Gubb, 2013). As compared to the US, the Swiss healthcare providers sector raised 6.3
percent in 2013, with a value of $76.8 billion dollars ("Healthcare providers industry profile:
Switzerland," 2014). By the year 2018, the Swiss healthcare providers sector is estimated to be
valued at $93.9 billion dollars, which is an increase of 22.3% from 2013. One of the largest
portions in the Swiss healthcare providers sectors is outpatient care, which accounts for 34.3%
of the sectors total value. Furthermore, the Swiss accounts for 3.8% of the European healthcare
providers sector value ("Healthcare providers industry profile: Switzerland," 2014).
An examination of the performance of the US pharmaceuticals and healthcare industry
for the third quarter of 2014, as well as a ten year forecast to 2023 conducted predictions on the
strengths, weaknesses, opportunities and threats (SWOT) faced by the sector ("United States

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pharmaceuticals & healthcare report.," 2014). The strong points were high per capita spending,
high pricing due to limited pricing restrictions, and sluggish growth rates as a weakness.
Prospects provided by increasing generic penetration while a huge number of patent expiries is a
threat. The US remains attractive to the pharmaceutical industry due to the affliction of disease,
increase in spending; new medicines are embraced quickly and unregulated pharmaceutical
market. ("United States pharmaceuticals & healthcare report.," 2014). Sadly, this is not good
news for the US population, prescription drug costs, or the healthcare system.
Comparison
US trends show that the country spends considerably more on healthcare as compared to
other countries in the world (Reid, 2013). If this trend continues, Americas total healthcare
expenses per capita will be up to three times more per capita than any other country. These high
costs are indicative of the higher costs put in place by the healthcare providers, which creates
greater costs for those that pay their medical bills out of pocket, as opposed to those that paying
with their health insurance. Consequently, since 2002, the cost of health insurance has risen by
ninety-seven percent (Reid, 2013). This robust number is one explanation for why health
insurance coverage is not a priority for some Americans. Due to the high number of uninsured
and the number of citizens that never pay their emergency room bills, the unpaid costs are passed
on to taxpayers and are reflected in the bottom line cost of insurance premiums (Reid, 2013).
Furthermore, the US lacks the paucity for political willpower to control healthcare costs
with government influence (Jost, 2012). Politics in the US possess the belief of a pro-market and
anti-regulation, which rejects regulations as a more realistic approach. A bulk of the
expenditures are paid for by private sector, as well as public expenditures shared by the federal

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and state governments, which could make it complicated to devise a regulatory stratagem (Jost,
2012)
As mentioned earlier, Switzerland is composed of cantons, which are under one federal
government and like America, each canton has Parliament representation that were elected by a
popular vote ("Healthcare providers industry profile: Switzerland," 2014; The Commonwealth
Fund, 2015). Comparatively, the Switzerland government has been known to intervene on civil
matters when the private sector produces results that are unbecoming. Aside from its economic
advantage, Switzerland, like the US, operates on a free market system. With a large number of
uninsured Americans, there was an increase in higher insurance costs as compared to other
thriving nations (Reid, 2013). According to Reid (2103), there were close to sixteen percent of
Americans that are uninsured, which is considerably higher than other developed and functional
nations such as Switzerland. Today, approximately 98% of the Switzerlands population are
insured and the government is not the insurer (Reid, 2013).
The utilization of Swiss government run exchange of private health insurances serves to
provide coverage to all of its citizens, and subsidizes plans based on the individuals incomes.
The utilization of such a program by the US states who refused Medicaid expansion could aid in
filling in the coverage gaps (Reid, 2013). The European health systems contain rigid spending
controls, which the ACA lacks (Rice et al., 2014). It prohibits the formation of institutes for
assessment of the cost effectiveness of pharmaceuticals, health services, and technologies. These
are comparable to the National Institute for Health and Care Excellence in the UK of Great
Britain and Northern Ireland, the Haute Autorit de Sant in France or the Pharmaceutical
Benefits Advisory Committee in Australia (Rice et al., 2014). Furthermore, due to the lack of
consensus across the political parties the ACA was weakened and its performance, as well as

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acceptability by the American population, will be vital in determining the future of the ACA
(Rice et al., 2014).
Moreover, Schoen et al. (2011) studied primary care physicians view on healthcare,
which indicated a need for enhancement in all countries through redesigning primary care, as
well as the need for developing the care teams accountability across sites of care. Furthermore,
a need for development of managing transitions and medications. The US severely ill were most
likely to omit needed care due to the financial burden. Individuals in Switzerland & UK reported
more positive experiences than those in other surveyed countries. However, the results revealed
that in all the countries, care is often poorly coordinated (Schoen et al., 2011). Coordination of
patient care was noted to be a greater issue in the US versus Switzerland.
In addition, another study performed by Schoen et al. (2012) demonstrated that primary
care physicians in all the countries surveyed reported not receiving information in a timely
manner from specialist and hospitals (Schoen et al., 2012). US physicians reported spending a
substantial amount of time tackling insurance restrictions, which led to an increase in stress, less
time with the patient, and the patient often went without care due to the cost. Furthermore, the
US physicians surveyed reported that the healthcare system needs modifying. E-mail and webbased portals could contact two-thirds of the Swiss doctors (Schoen et al., 2012). Half or more
of the physicians in Switzerland reported patients could refill prescriptions online, compared to
merely one-third or less of the physicians in the US (Schoen et al., 2012). Consequently, the US
uses less technology in coordinating patient care and spend more time addressing non-clinical
issues associated with healthcare.
Further, when addressing costs associated with the US healthcare system, it is important
to consider the views of physicians. Tilburt et al. (2013) examined US physicians attitudes

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concerning healthcare cost, as well as their role addressing healthcare costs. A total of 2,556
physicians responded (sixty-five percent), majority believed that the trial lawyer (sixty percent),
health insurance companies (fifty-nine percent), hospitals/ health systems (fifty-six percent),
pharmaceutical and device manufacturers (fifty-six percent), and patients (fifty-two percent)
have a major responsibility for reducing healthcare costs, compared to only thirty-six percent
reported that practicing physicians have major responsibility. Majority were very
enthusiastic for promoting continuity of care (seventy-five percent), expanding access to
quality and safety data (fifty-one), and limiting access to expensive treatments with little net
benefit (fifty-one) as a means of reducing health care costs (Tilburt et al., 2013).
However, there is a small amount expressed enthusiasm for eliminating fee-for-service
payment models (seven) (Tilburt et al., 2013). A large number of physicians stated being
aware of the costs of the tests/treatments recommend (seventy-six percent), agreed they should
adhere to clinical guidelines that discourage the use of marginally beneficial care (seventy-nine
percent), and agreed that they should be solely devoted to patients best interests, even if that is
expensive (seventy-eight percent) and that doctors need to take a leading role in limiting use of
needless tests (eighty-nine percent). Majority (eighty-five percent) disagreed that they should
sometimes deny valuable but costly services to certain patients for the reason that resources
should go to other patients that need them more (Tilburt et al., 2013). Interestingly, most
physicians view the responsibility of lowering healthcare cost as someone elses.
Insurance companies play a major role in the cost associated with healthcare in the US. A
2010 survey examined the insurance-related experiences of adults displayed a substantial
difference in access, burdens of cost, and issues with health insurance related to the insurance
design (Schoen et al., 2010). Adults in the US incurred higher medical expenses with insurance,

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more likely to spend time filling out insurance paperwork, and attempting to resolve disputes
concerning payments of coverage denied or having payments denied by insurance companies.
However, the Swiss out-of-pocket spending was high; nonetheless, hardly any Swiss had access
concerns or difficulties paying bills. Healthcare reform in the US population could lead to
improvements in many of the aforementioned areas (Schoen et al., 2010).
The ACA sought to remedy the number of uninsured Americans, however when the
Supreme court ruled that the states did not have to comply with the Medicaid expansion there
remained a concern that some lower and middle class Americans may fall between the cracks of
the insurance system (Reid, 2013). In comparison, Switzerland manages to insure approximately
ninety-eight percent of its population without a welfare system such as Medicaid. The utilization
of Swiss government run exchange of private health insurances serves to provide coverage to all
of its citizens, and subsidizes plans based on the individuals incomes. The utilization of such a
program by US states who refused Medicaid expansion could aid in filling in the coverage gaps
(Reid, 2013).
While prescription drug spending is a minor portion (11%) of personal healthcare
spending, it remains as one of the rapidly growing areas (Dada, 2014). Pharmaceutical
companies spend funds on marketing to consumers and if Congress limited marketing, it could
potentially reduce the cost passed on to consumers in the price of the drug. Thus, allowing the
government to spend less of the healthcare budget on prescription drug costs and use it towards
expanding the ACA to deliver accessible and affordable care for the entire population (Dada,
2014).

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Conclusion
A viable health system contains three key attributes, the first of which is affordability, for
the American population, employers, and the government with the recognition that employers
and the government rely on individuals as consumers, employees, and taxpayers for their
resources (Fineberg, 2012). Affordability is achieved in the Swiss system through strict
government regulation of competition amongst insurers, whereas the US relies on a free-market.
Additionally, the subsidies paid directly to its citizens ensures they purchase a health plan. While
the US offers subsidies to its citizens, compliance with obtaining health insurance remains less
than 98%. The second attribute is acceptability to important constituents, which includes the
patients and health professionals. Acceptance of the mandatory health insurance law was an
easier transition for the Swiss due to government regulation of insurers and equalization of
premiums. In addition, due to political divide, the ACA was not as accepted. The last aspect is
adaptability because health and healthcare needs are not static (Fineberg, 2012).
In conclusion, there are numerous aspects to contain consumption and costs in healthcare
(Squires, 2012). Spending cannot be attributed to higher income, an aging population, an
increase in supply nor the use of hospitals and doctors. Cost of healthcare in the US is attributed
to higher prices, potentially due to easy access to technology and increased rates of obesity. The
quality of healthcare in the US varies, and is not better than that of less expensive countries
(Squires, 2012). The future of healthcare and the ACA in the US will rely heavily on the next
elected administration in 2016.

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