Sickness (or, the Tyranny of Healthcare)

I've been out with the extreme ickies for the past 2 days (going on 3). So I thought it time to elucidate upon on our experiences with the insurance/medical system here. A lot of expats will write up something on how the CH system differs from their own, but rarely do they talk about actually using it.

I also have very little idea of what is happening back in the old country - only that a communist has taken over the government and is forcing everyone to participate in a healthcare system that is a lot like what we have here. A bunch of people feel the communist government should be overthrown lest they be subjected to the tyranny of forced healthiness. So here's a little bit about what we have.

The Facts:

Every person in CH is obligated to have health insurance, and to acquire it on their own; one's job does not provide health insurance (they do sometimes work with insurance companies to get their employees small discounts, as does mine). For some reason one's job does provide accident insurance. Within 3 months of arriving in CH one is required to sign up with a health insurance company. There are something like a gazillion insurance companies. Every company is required to offer a basic standard level of insurance to all that request it (i.e. pay for it) and supposedly you can't be denied. This standard level is actually pretty good. The companies compete on price and services, and by offering different packages. They save money by reducing the bureaucracy and administration fees. If someone can't afford the insurance, the CH government steps in. So in effect, everyone gets covered (sounds awful, doesn't it?). Some people, don't ever get insurance. They cheat the system (no one ever checks really). If ever they were in an emergency, the government would find out somehow and assign them an insurance plan (at random for all I know).

We chose one that was a little more expensive than most because they offer their services in English. We also pay for the "next level up" as it were. We know exactly how much our insurance costs every year, and it's a lot. And it went up with the new year. We even have a fairly high deductible which lowers the cost quite a bit.

People are allowed to switch plans only during a certain time of year (i.e. the end of it). This seems rather arbitrary. So at the end of the year you see ads talking about switching and new plans and comparis.ch ramps up advertising its really good plan comparison engine and will even notify you when plan switchin' time is near.

When you go to the doctor, they ask you for your insurance company, but then bill you directly. We have been able to see any doctor we have wanted to. You receive all your own bills and see how much everything costs. Once you receive a bill, you simply send it into your insurance company. They then deposit into your checking account what their contribution is and send you a transaction record every month. The process has worked very well thus far. This constant back and forth in turn must fund the postal system somehow as well.

What we have experienced:

1) We had a baby. We did not pay anything - it was all covered under the BASIC coverage. We did however pay CHF 20 to the hospital to (in reality) completely screw up the birth certificate. Everyone in the hospital was SUPER awesome. Obviously, our doctor was already picked by us so we knew he was good. We had a really hard time finding him though - most are booked with patients and aren't taking any more. Everyone at the hospital spoke English with Alison and saw it as somewhat of a novelty. We did not get to experience any of our coverage "upgrades" because most plans (at least ours) do not allow you to tap this until after a year of coverage. So basically until this June we are under basic coverage.

All CH plans allow visits with a midwife for two weeks after birth as part of basic coverage. We opted to leave the hospital a day early and meet with a midwife as a followup. This was covered under this provision so it was very handy. We found her from a list provided to us by the hospital, she came to our apartment, did a test on Daniel and actually ended up billing the insurance company directly. Meeting with her was a nice personal-touch type experience.

2) We have been visiting the health center that our insurance company offers. We haven't had to pay for any of it. The health centers give out prescription meds on site at the reception desk (no need for a trip to the pharmacist). They give out generic brands. One doctor Alison saw spoke English, and for some reason the doctor I see doesn't (very well) so he and I speak German. Kind of weird.

3) Coincidentally (or perhaps not) we have twice had need to visit the urgent care doctor after hours during a holiday. There is a 24hour medical phone line that the cantons of Bern and Luzern offer (medphone.ch) for medical advice and will make appointments at the "on call" doctor for the evening. At least for children's doctors, one is available in town every evening for urgent care needs, and it rotates among the well known doctors. We did this once for Noah and once for Daniel. So instead of going to the emergency room somewhere and waiting for hours (which we could have done as well) we have been able to make appointments and see doctors almost immediately. Both doctors we saw, were able to give us medication on the spot. I think we ended up paying CHF 15 for one of these visits as part of our deductible or it might simply not have been covered.

4) We chose a good children's doctor suggested by the US Embassy and by the midwife we met with after Daniel's birth. Regular visits have thus far all been covered. He is also administering the same immunization schedule as in Minnesota per our request (which is pretty close to the CH schedule).

5) Do you want to know what IS really expensive? Over the counter drugs. Pop into a pharmacist and ask for Zyrtec - I think it's CHF 20 for 10 pills where you can get 100 for $30 in the US. Ibuprofen is CHF 1/pill. Do the math.

6) There are also a bunch of things you can't get here except from a doctor - children's claratin, children's tylenol, pedialyte. See the pattern? At first we were taken aback as we were so used to being able to self-diagnose everything. That, is medical savings in the US - DIY. In CH there appears to be the unwritten rule that children's health is paramount and to be controlled by a doctor just to be safe. You get used to it. Our children's doctor is reachable over the phone and in person very easily - his office is 2 blocks away.

Overall, for us, the system has worked quite nicely and is pretty much just like back in the old country. It's obviously expensive and projected to be even more so over the years (CH folk are just as worried about that). We have had much quicker and direct/personal access to actual doctors though. Score one for CH - although I don't know what it would be like in a different (and perhaps larger) CH city/Canton. Basic coverage is actually very good and we probably didn't need to get the "next level up." If rates go up again this year, we will probably reduce my coverage to basic.

Anywho. That is our experience here in a foreign land. I watched this Frontline episode a long time before we came over - a very good compare and contrast between a bunch of good systems, including the CH system.

Caveat emptor - these are our experiences. Your mileage may vary.

Marktgasse Nebeneinanderstellung

Just remembered I had these two shots ... Marktgasse is the main shopping street between the Zytglogge (clock tower) and the Bahnhof. Saturday afternoon absolutely everyone was out purchasing stuff for the coming two day holiday (Easter Sunday and Monday) during which most of CH would surely starve to death unless groceries and H&M clothing were purchased right then.

Berner Eiertütschen

Some traditions are simply too odd to pass up. This morning, Noah and I headed out to enjoy a quick round of Eiertütschen. Strangers gather in front of the Kornhaus cafe with (sometimes) dozens of hard boiled eggs and challenge each other to rounds of "smash the egg." More of a social event really. You start out with the "sharp" end of the egg, then if neither egg is broken, you continue on to the "fat" end. Small taps on each end. The "winner" takes the broken egg. I haven't decided if its really winning though. Some people bring bottles of prosecco and small picnics and enjoy an hour or so of fun with strangers.

Other than that, the town was d..e..a..d ... dead ... dead. It was fun to walk down the middle of the streets and play choo-choo on the tram tracks though. Managed to get in a quick "I'm too shy" shot though.

Gründonnerstag

And as Daniel and I were walking through Bern this Gründonnerstag (that's today) what did we see? Why ... of all things ... the Polizei arresting a bunch of Santa Clauses on the Bundesplatz.

Just can't make this stuff up.