The Swiss might eat more chocolate per capita than people from any other nation in the world, but you wouldn't know it by looking at their health care stats.

Some say that Switzerland's health care system can provide inspiration, or serve as a model, for the restructuring of the U.S. health care system. Switzerland spends 10.8 percent, or $7,076 USD per capita (30 percent less than the U.S. spends per capita), of its gross domestic product on health care. They boast excellent health care service and enjoy long and healthy lives. Moreover, according to several indicators, the Swiss are healthier than Americans and are, as Nelson Schwartz of The New York Times reports, "generally happy with their system." (Switzerland does, however, still have high health care costs -- exceeded only by the United States and Norway.)

Harvard University's Regina Herzlinger, whom I listened to speak at an AARP and Swiss Embassy event last week, has done extensive research on Switzerland's health care system. In an article for the Journal of the American Medical Association (subscription only), she selects three U.S. states that have similar socioeconomic and population characteristics to Switzerland and demonstrates how the Swiss have lower health care expenses but equal or better health outcomes than the U.S.:

Switzerland guarantees quality health care coverage to all its residents, and does so without a government-run plan. It does not "resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States." Instead, the Swiss rely on a public-private model that might be an appropriate template for policymakers in Washington to draw on.

The Swiss system has attracted attention because of "its use of an individual mandate combined with public oversight of the insurance market." The 1994 Health Insurance Law (that went into effect in 1996) requires that all residents of Switzerland purchase a private basic health insurance plan from one of the competing insurance companies. In return, the insurance companies must accept all applicants during the annual open-enrollment period and offer guaranteed coverage and renewal with community-rated premiums. Families can receive insurance subsidies from the government that vary depending on where they live. (About 35-40 percent of Swiss households receive a health insurance subsidy.)

Below are the main features of the Swiss health care system:

• All insurers that offer the mandatory basic plan need to register with the Swiss Federal Office of Public Health. The health insurance market is decentralized and operates at the canton level (there are 26 cantons and each can have up to three regions.)
• There is no group coverage, coverage for dependents or employer sponsored insurance; all plans are purchased on a per capita basis.
• Most people purchase additional supplementary coverage for services excluded from the basic package (dental coverage, for example). Often times, an insurance company will have a non-profit branch that offers the basic plan and a for-profit branch that offers private, supplementary insurance.
• Basic plans have a minimum deductible and coinsurance requirements; enrollees may opt for a higher deductible and obtain a reduced premium. (There is a minimum deductible of $225 and maximum deductible of $2,125. Once the deductible has been met, enrollees pay a 10 percent coinsurance rate with an annual maximum of $595. Maternity care and several preventive services are excluded from the deductible.) Switzerland tends to have relatively high out-of-pocket expenditures.
• Aside from some variations in deductibles; individual insurers can vary premiums only according to age group (0-18, 19-25, 26 and older).
• Insurance companies are free to set the prices for individual policies, but the Federal Office of Social Insurance has the power to reduce the price.
• There is a risk equalization system that redistributes premium revenue among insurers according to the age and sex of their enrollees. This helps insurers with high-cost risk pools.
• The Swiss have the option to change insurers each year during the annual open-enrollment period.

Many of the reform proposals floating around Washington mirror specific elements of the Swiss system.  "The mix that Switzerland represents between private enterprise and general state regulations that make health care accessible to everyone is really an interesting example for the US," states Felix Gutzwiller, a senator and head of Zurich University's department of public health. Both the House and Senate health reform proposals, for example, include an individual mandate (with hardship waivers), government assistance for those that cannot afford insurance premiums, limits on age rating and prohibit coverage denials due to pre-existing conditions.

But as Uwe Reinhardt states in an article for JAMA, we "need not import another country's political system or social ethic to learn from the techniques they use to seek cost-effective health care." We can look to the Swiss system (and other European systems as well) for some good pointers on how to provide cost-effective, quality care to all Americans. The Swiss system represents American values of competition, choice and quality, and we may want to import some of their ideas -- and their chocolate!