A new Commonwealth Fund study says that the United States should adopt the policies of Switzerland and the Netherlands.    Those countries have near-universal coverage, though they have to subsidize up to 40 percent of families since individual health coverage is mandated by law.

The result?  Both countries effectively cover all but one percent of their population, compared with 15 percent uninsured in the U.S.   Though they subsidize 40 percent of the population due to the high insurance cost, they have been successful at curbing administrative costs: the Swiss and Dutch health systems spend about 5 percent of health care costs on administrative costs, compared with an average of 7 percent in private insurance policies in the U.S.

Both Switzerland and the Netherlands have mixed public-private systems with an individual mandate and insurance market reforms that are similar to the Massachusetts universal coverage law. Both countries' health systems also feature broad access to care and low rates of disparities in care, according to the study, The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets, by Robert E. Leu of the University of Bern, Switzerland and colleagues.

Key policies they like:

  • Universal coverage attained through a mandate that every individual purchase a basic insurance plan. Both Switzerland and the Netherlands subsidize premiums for low-income households, with about 40 percent of households receiving premium assistance in both countries.

  • National standards for basic coverage for private insurance ensure that benefits are comprehensive for acute care services.

  • Tight regulation of basic health insurance markets, with requirements for open enrollment and community rating, lead to relatively low overhead costs. Administrative and profit-margins account for about 5 percent of premiums.

  • Risk equalization systems help to reduce incentives for insurers to seek healthier enrollees.

While the U.S. spent 15 percent of GDP and $6,700 per capita on health care in 2006, Switzerland spent 11 percent and the Netherlands 9 percent of GDP on health spending; per capita spending was $4,300 in Switzerland and $2,800 in the Netherlands. Both countries achieve better health outcomes compared to the U.S.: in 2005 life expectancy in the U.S. was 77.8 years, compared with 81.4 years in Switzerland and 79.1 years in the Netherlands.