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Old 17.04.2017, 12:16
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Health problem and question about insurance

Hello

First one big thanks about wonderful forum and community here-you can find almost everything if you are interesting in Switzerland.

Me and my relative are thinking to move in Switzerland(as one of many option that we have).
But my relative is a little worried because she has a health problem(problem with Thyroid)-noting serious-she is feeling fine and everything is under control but:
-she everyday drinks pills/medicine
-She needed to go on regular check(every month) and if needed some tests(major prophylaxis).
I use a calculator for health insurance in Switzerland and the insurance will be around 300 Franks per month(Basic insurance)-2500 Franks payed out of pocket before the insurance come in place.
So i want to ask you:
1)The basic insurance will be enough or not ?
2)If all 2500 Franks are payed for one year-the insurance company will pay the rest if it is needed or not ?
3)If it is needed some operation,the insurance will cover it ?
4)Is it possible,the insurance company to refuse to cover/give a health insurance.
5)Do you know that are the average cost of regular checks in Switzerland.
P.S
I am sorry,if some of the questions look stupid,but the majority of the time my experience is with State healthcare and i don't have big experience with Health insurance and the System in Switzerland.
Thanks in advance.
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Old 17.04.2017, 12:40
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Re: Health problem and question about insurance

Basic insurance will be perfectly adequate and will cover her for everything she needs.
You may want to play around with the different health insurance plans and see which works out best for you. With a chronic condition that needs regular check ups and medication it might work out cheaper to choose a lower deductible and higher premiums.

Once you have reached the deductible (2500 in your example) the insurance will reimburse you 90% of the cost of the treatment for any further treatment during that year. If the total cost of the treatment exceeds 7000chf within the year they will reimburse you 100% of the costs as your 10% contribution is capped at 700chf.

If you take a 2500 deductible the most you will pay in a year is 300x12 (premiums) + 2500 (deductible) + 700chf copayment = 6800chf.
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Old 17.04.2017, 12:41
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Re: Health problem and question about insurance

Welcome to the Forum
If you skip back to the top of the section where you posted this, you'll see a Sticky Thread.
The answers to your questions and a lot more, are in there. "Jenny" is an expert!
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Old 17.04.2017, 13:18
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Re: Health problem and question about insurance

What nationality are you? That affects what relatives, if any, can join you here.

I would not go for the highest franchise. Yes, the premiums are lower if you do, but you also have to pay that amount out first before the insurance kicks in.

Swiss basic health insurance has to cover you. Insurers aren't allowed to exclude anyone because of a pre-existing condition.
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Old 17.04.2017, 14:44
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Re: Health problem and question about insurance

I would also recommend that your relative choose an insurance model that allows her to see a specialist on her own, as opposed to needing a referral for every appointment from a GP. This model is usually referred to as a traditional model. This model, rather than an HMO or Telmed plan, might be a better fit for her health needs.

Key to treating thyroid disease in Switzerland is finding a doctor who truly understands the issues. Unfortunately the GPs I have seen here have not been able to do much beyond checking T4 against a standard chart, and by sticking with a GP not really qualified to deal with the disease valuable time was wasted. If your relative has a complicated thyroid history, especially something like Hashimotos, she will likely need to see a good endocrinologist.

Where a good GP is useful, though, is in helping your relative to get to see an endocrinologist more quickly than she could on her own.

Be aware that it can take a long time to get an appointment with an endocrinologist, especially if self-referring. IIRC, I was able to get an emergency appointment through a clinic referral in 'only' two months. The normal wait for a first time appointment can be several to six months if non-emergency, and with my endocrinologist one must make the follow up appointments six months to a year in advance.

I'm pointing this out because you mentioned that your relative sees the endo every month. Is this frequency because she is not yet stable on her meds? Once stable the usual cycle here is less frequent. But nonetheless, be aware of the need to schedule appointments well in advance.

To get in to see an endocrinologist for a first appointment with less of a wait time you will likely need a GP referral. Have your relative bring all paperwork, blood test results, copies of the ultrasounds, any comments from her current doctor - this can help to get a GP to take her condition seriously, skip the usual faffing around steps, and help you get that first endo appointment.

Wishing you and your relative all the best.
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Old 17.04.2017, 17:35
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Re: Health problem and question about insurance

Thanks for the worm welcome

So we are both EU nationalities(if EU don't blow soon with the big movements of nationalist in Europe )

meloncollie
Yes,you are absolutely right-She needed a specialist,not a GP.
Everything with her conditions is fine and she has a normal live and if i don't tell you , you will never understand that she has this problem-as i said the only needs are:
-to take her pills every day
-To go on regular check and make tests(if needed).
I don't understand way is needed to wait so long to see endocrinologist(up to 6 months).
The Swiss healthcare have a reputation as one of the best and it is not a state healthcare(notorious with their long weights).
She cant simply go to endocrinologist and even to pay from her pocket(if it is needed) or the insurance will not cover it,if go after the limit ?
Belgianmum
Thanks very much for the info.
So if i understand correct:
-up to 2500 -you pay 100 % plus your monthly health insurance(premium)
-from 2501 to 7000-you pay 10 % and insurance company pays 90 %
-7001 to More-The insurance company pays almost 100 % and you pay flat 700 Franc...........even if it is a 1 000 000
Is this correct ?

And what health insurance will advice to to choose(For my self i will take the cheapest because i don't have any health problem),but for her:
How much deductible to choose(from lowest 300 to maximum 2500) ?
And which is the best model for her:
-free choose of doctor/Standard model (the most expansive)
-Family doctor model(15-20 % less)
-HMO model(25 % less)
-Telmed model(15 %-20 less).
As i see from the description,the best model for her is "free choose of doctor"
-Free choice of doctors at all times
-You can go to a specialist directly
So this is the best for her or the HMO model is good too(there are several specialist there)?
P.S
According to calculator(https://en.comparis.ch) the insurance(total) will cost total 658 franc monthly with HMO model
(CHF 288.10 for me and CHF 369.90 for her)-my are 2500 deductible,hers 1000 deductible).
Even the lowest offer starts form 548 franc(Totally for both of us)
If i use standard it will cost 748.60
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Old 17.04.2017, 18:06
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Re: Health problem and question about insurance

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I don't understand way is needed to wait so long to see endocrinologist(up to 6 months).
The Swiss healthcare have a reputation as one of the best and it is not a state healthcare(notorious with their long weights).
She cant simply go to endocrinologist and even to pay from her pocket(if it is needed) or the insurance will not cover it,if go after the limit ?
The possibility of waiting times for an endocrinology (or any) appointment have nothing to do with insurance or payment, but rather that the good endocrinologists tend to be very busy. Unless it's an emergency you might find that the next available appointment is not for several months, you have to wait until there is a slot free.

It's simply supply and demand.

As above, routine follow up appointments with my endo need to be made well in advance, she is very busy. However if, as an established patient of the practice I suddenly had an emergency I would likely be seen relatively soon. This is not uncommon; good doctors are often in high demand, and a well-run practice usually keeps the schedule such that an emergency can be fit in at short notice. But one should never cry 'Emergency!' when it really isn't, that would be an abuse of the practice's trust. Patients new to the practice often do have to wait for an introductory appointment, again: supply and demand.

When your relative comes over, make finding an endocrinologist a top priority, and get an appointment set up as soon as possible. If you are new to the area, it would be wise, though, to find a GP who can help you by referring you. A referral usually helps to bypass or shorten the usual new patient wait list.

Who knows, you could get lucky and find an endo with more capacity than other practices, and thus not much of a wait. But I'm offering my experience so that your relative is prepared, and can take steps to ensure that her medical needs are met.
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Old 17.04.2017, 18:23
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Re: Health problem and question about insurance

No, it's:

-up to 2500 - you pay 100 %
-from 2501 to 7000 - you pay 10 % and insurance company pays 90 %
-7001 to More - insurance pays 100%. You pay nothing of the medical costs for the rest of the year.

And yes, you're still paying monthly premiums the whole time. But bear in mind that medicines are expensive here. A 3 month supply of Aubagio tablets for Multiple Sclerosis costs over 4,000 francs. And that doesn't include GP checks, regular blood monitoring, MRI scans and neurosurgeon follow ups also needed. So even if you're on the standard basic insurance you may find that she'll pay nothing except her premiums for a good part of the year. And that 4,438.80 annual premium will seem like a good deal.
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Old 17.04.2017, 18:46
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Re: Health problem and question about insurance

With any form of chronic illness that requires regular treatment that costs more than 5$ a month, I'd recomment to go for a higher premium and a lower franchise. It usually pays off.

I also second the recommendation to pay a few extra bucks to be able to see whichever doctor you want at whatever time without having to ask your GP first. Granted, one should not abuse this (it's only part of why healthcare costs have skyrocketed). But with a more permanent condition, it's worth it just in case. It won't necessarily lead to shorter waiting times as that has nothing to do with the insurance you have, but it gives you some freedom if one doctor isn't available for a long time, you can just go elsewhere without having to go back to your GP for a referral.
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Old 17.04.2017, 18:50
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Re: Health problem and question about insurance

Regarding the choice of deductible, the computations that I've seen and done can be summarized as follows. You might well want to check with the quotes that you see now though:

1) If your expected annual medical costs are well under 2500 CHFs (the highest possible deductible) then it is most economical to take a 2500 CHF franchise plan and expect to pay out of pocket. If something big comes up unexpectedly, you pay at most 2500 (franchise) + 700 (10% of next 7k of costs) on top of your premiums. This is a lot, but should not be ruinous.

2) If your expected annual medical costs are over 2500 CHFs, it is most economical to take the 300 CHF franchise. Your premiums will be higher, but at most you will only need to pay 300 + 700 more, and this saves overall compared to case 1).

If your annual medical costs are slightly under 2500, one of the intermediate premium might be optimal, but since it is hard to know exactly what your costs will be, it tends to be a bit of a guess.

Regarding choice of model: I have a normal (free choice) plan because I have a few things going on and like the flexibility. If something comes up I can ask around for recommendations of specialists and approach one without involving anybody else. If you'd always prefer to talk to a GP for a referral, the plans which require you to do that save you some money and could be worth considering. I also know people who prefer telemed, which saves even more - you have to call, but the call center can refer you to a specialist directly and some insurers use a service which can even issue a sick note for work, without requiring you to leave home for an examination.

Last edited by ThomasSSS; 17.04.2017 at 19:10.
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Old 17.04.2017, 19:05
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Re: Health problem and question about insurance

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The Swiss healthcare have a reputation as one of the best and it is not a state healthcare(notorious with their long weights).
That's a rather heavy statement, don't you think?
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Old 17.04.2017, 19:06
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Re: Health problem and question about insurance

Thanks
Now the things are looking more clear.
1)So which health plan i should choose(standard with seeing doctors and specialist everywhere or HMO model(Health center)-i hope that they have several located in the main areas and not to change my insurance if i am in Zurich and i go to the trip in Lugano(for example) and i need some medical help
2)So the basic insurance cover everything up to 2500 +700=3300 francs per year.But it is cover the pills/medicines if they are above the amount or they are excluded ?
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Old 17.04.2017, 19:09
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Re: Health problem and question about insurance

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As i see from the description,the best model for her is "free choose of doctor"
-Free choice of doctors at all times
Just a clarification:

The choice of doctor available in the traditional model refers to ambulant (that is, office visit or clinic outpatient) treatment, not a hospital admission. Hospital stays are something of a special case.

In a hospital setting the doctor you can be treated by (usually) depends on whether you have basic, semi-private or private insurance. Semi private insurance allows you to be treated by an Oberarzt, private insurance allows you to be treated by a Chefarzt. These are supplementary insurance options; with a pre-existing condition your relative is unlikely to qualify for supplemental insurance.

Some hospitals stick to this seniority restriction rather rigidly, while at some you might get lucky and find that a senior doctor handles the case at no extra cost. Several EF posters have reported this experience.

You also might have the option of paying an additional fee to be treated by a more senior doctor than your insurance allows.

The level of insurance you have also determines the kind of hospital room you will stay in. Basic is usually a 3-4 person room, semi- a two person room, private a private room. But again, you could also pay a fee to upgrade the hospital room.

But again, that is only for hospital admissions. The traditional model basic insurance generally allows you to see any doctor of any seniority in an ambulant setting.


---

Another thing you should understand: While the traditional model allows you to see a doctor of your choice, that is, the insurance will pay for it (subject to franchise and Selbstbehalt), you might find that the doctor will still not see you without a GP (or other doctor) referral. Some, perhaps many, specialists do this as a way to best utilize their time. They concentrate on patients who already have a preliminary diagnosis pointing to their specialty. Nothing to do with insurance but rather with the way they see fit to best structure their limited time. So while your insurer allows you to see the specialist without a referral, with out a referral some specialists still might not be willing to see you.
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Old 17.04.2017, 19:56
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Re: Health problem and question about insurance

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Thanks

2)So the basic insurance cover everything up to 2500 +700=3300 francs per year.
(My bold)

The basic insurance covers many things, perhaps most, but not all. Currently the government and other interested parties are reviewing the list of what is covered, with an eye to eliminating some procedures that do not provide sufficient benefit to justify the cost. For instance, arthroscopic knee surgery, iron infusions, are some that are being discussed.

Your doctor should inform you if he or she prescribes something not covered by basic insurance, but in practice this does not always happen. It is your responsibility to make sure that you understand your coverage.

For more information, click on the .pdf 'The compulsory insurance in a nutshell' linked at the bottom of the page below:

https://www.bag.admin.ch/bag/en/home...in-kuerze.html
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Old 21.04.2017, 12:36
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Re: Health problem and question about insurance

And what about if you need to call ambulance-is it cover the cost(if you reached /spend the maximum-3300 Frank) or not ?
And what is the average cost of ambulance ?
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Old 21.04.2017, 12:52
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Re: Health problem and question about insurance

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And what about if you need to call ambulance-is it cover the cost(if you reached /spend the maximum-3300 Frank) or not ?
And what is the average cost of ambulance ?
No, though you can get supplementary insurance to cover it. Iirc you can claim half the cost of an ambulance journey back on your basic insurance. As for how much it costs, I guess that'll depend on how far they have to come to get to you, what the problem is and which hospital they have to get you to.
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Old 21.04.2017, 12:58
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Re: Health problem and question about insurance

From the BAG page linked in my earlier post, page 7:


Medical transport and rescue:

 Special transport may be needed to take you for treatment (e.g. an ambulance, taxi). Your compulsory health insurance covers half the cost of this kind of trans- port up to a maximum amount of CHF 500 per year.

 Health insurance also covers half the cost of rescuing you if you are in mortal danger (e.g. after a mountaineering accident or a heart attack) up to an annual maximum amount of CHF 5,000 (applies only in Switzerland).


Ambulances are expensive, a large bill for the portion not covered by basic insurance is always a possibility - and thus the reason why many take taxis to the hospital.

If you qualify for supplemental insurance (this is an 'if', given your wife's condition) you can purchase policies that offer additional ambulance coverage options.

Given your situation, you might be well served by contacting EF member 'Jenny' for professional advice, as recommended in Longbyt's earlier post.

Last edited by meloncollie; 21.04.2017 at 13:09.
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Old 21.04.2017, 14:04
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Re: Health problem and question about insurance

Thanks to everyone-now the thing are more clear.
I have one general questions(after reading about Switzerland healthcare and reading your answers).
1)Is it affordable the health care in Switzerland-as i see,with the average 300-400 franks per month for health insurance this is around 10 % of your income(even less,but lets say 10 %)
2)How would you described the Swiss healthcare(good,bad,very good) and are you satisfied with it(not that there are some weaknesses),but generally looks good(from outside):
-affordable price(for the income there)
-great quality
-maximum amount of money that you can pay for the majority of the cases
As i said,there are some weaknesses but generally looks good.
What is your opinion as a resident there ?
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Old 21.04.2017, 14:41
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Re: Health problem and question about insurance

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Thanks to everyone-now the thing are more clear.
I have one general questions(after reading about Switzerland healthcare and reading your answers).
1)Is it affordable the health care in Switzerland-as i see,with the average 300-400 franks per month for health insurance this is around 10 % of your income(even less,but lets say 10 %)
2)How would you described the Swiss healthcare(good,bad,very good) and are you satisfied with it(not that there are some weaknesses),but generally looks good(from outside):
-affordable price(for the income there)
-great quality
-maximum amount of money that you can pay for the majority of the cases
As i said,there are some weaknesses but generally looks good.
What is your opinion as a resident there ?
Probably nearer 5%, low earners get financial support.
Its good & quick
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Old 21.04.2017, 15:23
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Re: Health problem and question about insurance

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What is your opinion as a resident there ?

I think we'll all have very different perceptions based on what kind of health care we were used to back home vs our experiences here. From reading posts on EF I know my experiences are indeed different to what others have come across. So please take my comments as background anecdotes - and make your choices based on your own needs and research.

So... I come from the US and have lived in Asia. Everywhere else I have lived I had 'gold plated' insurance coverage, provide for free or at a nominal cost by my employer or as part of OH's relocation package. We had 'free' gold plated corporate coverage in our first 5 years here on an expat package, by the way. (Never needed it back then, though.)

Once OH switched to local status we had to switch to Swiss insurance, bearing the costs ourselves.

In a nutshell, from a cost standpoint I am happy with Swiss healthcare and insurance coverage.

Yes, my basic plan here (I did not qualify for any supplemental plans due to age and pre-existing conditions) is expensive compared to my 'free' insurance in the past, but my realistic point of comparison is what I would have had to pay back home without that company insurance - and that would be double or more the cost of Swiss insurance.

Not to mention prices for treatment in Switzerland are, on the whole, far less expensive than what similar treatment would cost back home, either to me or to the insurer. I've had to go back to the US for diagnosis (more on that later) while living here and believe me: US prices for a 'health tourist' are eye watering, almost out of the realm of payability. (Of course an insured person in the US pays a different price...)

Another aspect of the Swiss system that I like is the lack of bureaucracy or push-back from the insurer.

I recently had an operation here; all I had to do was give the local hospital my insurance policy, the hospital and insurer took it from there without needing my further involvement. I live in SZ, by cantonal law all bills must automatically go to the insurer, so there is no faffing around with paying upfront and then chasing a rebate - I just see the doc, then wait for a statement from my insurer. No administrative work on my part.

In contrast, much of my 'eldercare' responsibilities now involve fighting with Medicare (insurance for seniors in the US) to get my mother's bills covered as they are supposed to. In the end they always pay up, but it usually takes many hours of my time to navigate the system and do battle with administrative clerks. When I finally move back to the US I hope they cover the ulcer those battles have caused.

One area I am less than happy with healthcare in Switzerland as I have experienced it is access to quality care. I live a bit off the beaten track but certainly not in Nowheresville - yet we have few general practice doctors available and even fewer specialists. It took me a couple of years before I found a GP in the area who was taking on new patients, and several years more before I finally found one who was competent.

Good thing I speak German well enough to get by, as many local doctors largely either do not or will not consult in English. I believe doctors here do some portion of their studies in English, but that does not mean all are comfortable with or willing to practice in English.

Again, I am off the beaten track - other EFers have had very different experiences, have had no trouble finding a doctor willing to consult in English. It's not simply area-dependent, though, my endocrinologist in Zürich city (I have to go there, as there are no endocrinologists in my area) only consults in German.

But language isn't a complaint, I can get by without too many deadly mis-understandings in German.

No, my real disappointment is that many of the doctors, mostly GPs, that I have seen here do not seem to be trained to the standard I expect coming from the US.

That's why I had to go back to the US to get diagnosed, local docs simply didn't have the training, equipment, or interest in looking into something that was not clear-cut. But again, I am comparing the village doc to the Mayo Clinic, Northwestern, etc - likely not a fair comparison. I ran into the same lack of competency/interest at Unispital Zürich... but again, I could only see a junior doctor (he might even have been a student), I could not see someone senior. I had access to the top doctors in US medicine, whereas here I have had to accept that I will not get treatment at that level.

So my approach has been to use my Swiss health care providers first. If I run into a brick wall I go back to one of the top-notch medical clinics in the US for diagnosis. Once I have a concrete diagnosis, I can continue treatment in Switzerland. It's just the diagnosis phase where level of competency seems to fall short of what I am use to, among the doctors I have been able to see. Again, other posters will have very different experiences.

One area I have been disappointed here based on my experience with elderly friends is palliative care. Again, I only have a handful of second-hand experiences here (and far too much experience back in the US) so cannot offer anything other than anecdotes. But the difference in what the palliative programs that I experienced here and in the US offered patients and families was startling. Perhaps that difference reflects cultural values?

Again let me stress that these are simply my own personal experiences and cannot be read as a general judgement. Other EFers report very different experiences, and are happy with the level of care they have had and with access to care. You might not run into the difficulties I have had in getting access to competent care.

And: I suppose if I had lived in West Podunkville back home with no hospital or GP for a hundred miles I might think that Swiss doctors are awesome. It's all a matter of comparison to what one is used to.

On balance I'm content with Swiss health care - especially now that I have finally learned (the hard way) how to navigate it more efficiently.

And as I look at what the current administration and congress is trying to do to even my my gold standard care in the US ... it's faults (IMO) notwithstanding, I do think the Swiss system on the whole does a better job for the majority of the population.

YMMV, as always.

Last edited by meloncollie; 21.04.2017 at 15:35.
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