Should thin people pay less health insurance?

There has been talk of an obesity epidemic developing in Switzerland AP Photo/Franka Bruns

A proposal that sees those with a healthy lifestyle – basically the thin and the fit – benefiting from lower health insurance premiums has triggered controversy.

Speakers at a debate on ways to reduce Switzerland’s spiralling health expenditure argued that punishing the overweight was unfair and there were other ways of tackling the heath cost and obesity issues.

The idea had the support of the centre-right Radical Party’s Felix Gutzwiller, who is a doctor. It called for a voluntary system in which patients agree to a healthy lifestyle, measured by Body Mass Index (BMI) or a fitness test. In return they would receive lower health insurance premiums than others.

Gutzwiller argued that the model would encourage personal responsibility and prevention, saving costs for everyone.

Although rejected by the rest of the Radical Party, the idea has caused political and media waves. It formed the main topic of a Swiss Consumers’ Forum public debate this week in Zurich.

This was held after a Forum survey found that rising health system and insurance costs were top of the list of consumer concerns, for the third year in a row.

Speaking at the discussion was Gutzwiller’s party colleague Doris Fiala, who recently lost 17kg, who said that the party had not shown enough courage over the idea.

Switzerland’s weight problem – almost 40 per cent of the population are now classified as overweight and almost nine per cent obese – had risen to “epidemic proportions”, she said. Diabetes and heart problems were a result and the nation’s children were getting fatter.

Proposal flaws

But fellow panel member Heinrich von Grünigen, head of the Swiss Obesity Foundation, said there were flaws in the “BMI bonus” proposal.

“It would be interesting to have some sort of positive-negative incentives, even on a financial basis, but BMI is not suited as a measuring means,” he told swissinfo.ch.

BMI is calculated from a person’s weight and height to estimate a healthy body weight. A BMI of 18.5 to 25 may indicate optimal weight. Over 30 is considered obese.

“We have people with a low BMI who are much more apt to get illnesses than those with a slightly higher-than-normal BMI but are still active. These people with a slightly high BMI fare better than those with a low BMI who are lying around taking drugs or whatever,” von Grünigen said.

In any case, studies have shown that financial incentives, normally so effective, do not appear to be so for weight loss, he said, so it was not clear what could be done.

“One solution would be to make healthy food cheaper and unhealthy food more expensive,” he added.

Punishment of poor

Franziska Troesch-Schnyder, president of the Swiss Consumers’ Forum, said the BMI idea was one-sided, targeting poor, hardworking people, many of whom had a migration background.

“You can’t punish them by asking them to pay more than those who can afford a fitness trainer, have time to exercise and the money to buy healthy food. We don’t think it’s a fair solution and it doesn’t save a lot of money.”

And while Felix Schneuwly from Santésuisse, the Swiss Health Insurance Association, was not against incentives to cope with weight problems, he could not see the idea working either.

“It’s too complicated to check that people are doing the right things to manage their weight. It would be too expensive, especially in administration,” he told swissinfo.ch.

Getting a grip

All participants agreed that Switzerland needed to get a grip on its health expenditure, which according to the latest official figures cost SFr55.3 billion ($51 billion) in 2007, making it one of the most expensive health systems behind the United States and France. The Swiss Economic Institute (KOF) predicts a rise to more than SFr60 billion for 2009.

Von Grünigen said targeting the overweight, who cost ten per cent of the health budget, was not going to lower spending significantly. It would be better, he said, to save money elsewhere, such as by stopping patients “doctor-hopping” until they get a diagnosis they like.

Schneuwly pointed to a lack of competitiveness in the health system, especially among health professionals, saying there should be incentives for them to do a better job for less money.

A fair solution, argued Troesch-Schnyder, would be a package of measures that would hurt everyone a little rather than target one group.

“Otherwise we won’t even be able to keep the costs at the same level,” she told swissinfo.ch. “You can only dream about reducing them. We have to do something.”

Isobel Leybold-Johnson in Zurich, swissinfo.ch

Health system

Switzerland has compulsory health insurance coverage, giving access to a broad range of medical services.

Switzerland spent SFr55.3 billion ($51.1 billion) – 10.8% of GDP – on health in 2007, making it one of the most expensive health systems, behind the US and France.

The increase in health costs for 2007 was at 4.9%, which was above the 3.1% average rate of the previous years.

Almost 43% of the total costs are covered by social security, 40% by individual patients and 17% by the state.

Health cost woes

In 2008 voters rejected a proposal aimed at simplifying the hospital funding system putting private insurance companies in charge of hospital care.

Five previous attempts to cut costs included an overhaul of the insurance system, the financing of hospitals and hospital care, as well as cutting costs of medicines.

In 2009 parliament threw out most of a package of cost-cutting measures put forward by the outgoing interior minister, Pascal Couchepin, which included a controversial fee for patients who consult a doctor and introducing phone consultations by health insurance companies. The last debate on the issue will be in March.

A cross-party parliamentary group also suggested a package, including making it more expensive for patients to go straight to specialists in order to encourage them to go to a GP first. They estimated this would save SFr1.5 billion. It had the support of the Swiss Consumers’ Forum. This proposal also did not get very far.

Premiums for mandatory health insurance are to increase by an average of 8.7% in 2010, the biggest rise in seven years.