The Swiss have ‘death panels’, in the parlance of the demagogues and their crazies. In the real world terms, the Swiss use comparative effectiveness analysis to determine what should be covered by their national basic comprehensive health policy. Not only for outpatient drugs, but for medical tests, and equipment, and sometimes procedures. The current system has been in operation in its present form since 1996.

As we will see below, the Swiss comparative effectiveness program shows no evidence of harming the elderly at all. In fact, their recent performance in providing long life to the elderly is better than ours. I doubt the demagogues or the crazies can be persuaded by the facts, but perhaps people who are rational, but worried by the lies, can be persuaded. So if you know of some on in that category, please spread the word. It also might be interesting to ask the media why they cannot report any facts about how comparative effectivess analysis has worked in other countries, rather than broadcasting sensational nonsense.

The Swiss national cost-effectiveness panel classifies outpatient drugs, tests and medical devices into four categories: a) indispensible, b) needed for good medical care, c) conditionally necessary, and d) unneeded. Items in category a) and b) are automatically covered by the basic plan. Items in category d) are excluded from coverage. Items in c) are given a cost-effectiveness analysis and included if the cost of acquisition is acceptable.

Medical procedures are given a formal cost-effectiveness analysis if a private insurance company asks for one.

Supplemental insurance policies are available for those who want more goods and services to be covered. and benefits for those are determined by the individual insurers on the private supplemental insurance market.

The Swiss approach is stricter than the plan proposed for the US, and than the existing one in Germany. It is similar to the approach used in Australia (the Australian program only covers drugs, but it covers all drugs, not just outpatient).

Let us see whether the Swiss ‘death panels’ have killed off the elderly since 1996.

The average life-expectancy of men at age 65, for years 1993 to 1995, was 16.0 years in Switzerland and 15.4 in the US, for a difference of 0.6 years. For the years 2004 to 2006 it was 18.2 in Switzerland and 17.2 in the US for a difference of 1.0 year.

The average life-expectancy of women at age 65, for the years 1993 to 1995, was 20.3 years in Switzerland and 19.0 in the US, for a difference of 1.3 years. For the years 2004 to 2006 it was 21.8 in Switzerland and 20.1 in the US for a difference of 1.7 years.

The life expectancy of the elderly in Switzerland is higher, and has been growing consistently faster, than in the US.

A previous post showed that the facts contradicted the lies about ‘death’ panels in Australia and Germany (http://seminal.firedoglake.com/diary/6766). The life expectancy of the elderly in those two countries has been growing faster than in the US. This post shows it is also not true in Switzerland.

And it makes sense, when you think about it. The use of comparative effectiveness analysis is to aid doctors in using the cheapest methods first, whenever they have a choice. That means that there will be more resources available for everyone. It does not have to lead to rationing. And the issue of it leading to rationing is an absurd objection in the US anyway, since our private insurers deny care all the time with little or no accountability. It would be far better to have a public process to evaluate treatments.

In fact, a recent 2006 OECD/WHO report criticizes Switzerland for not using cost-effectiveness analysis enough in shaping its policies. Even though many preventive and health screening programs (including breast cancer screening in middle age women) have been found to be cost-effective, the Swiss have been slow in implementing them. The report concluded that if Switzerland acted more often on its own cost-effectiveness program’s guidelines, it could reduce costs and increase its population health.

Note that this diary is not an argument that comparative effectiveness analysis was the sole cause of the better recent performance in Switzerland. It is intended to simply confront lies about ‘death panels’ and comparative effectiveness analysis with the facts. The liars say that comparative effectiveness analysis (as with voluntary end of life counseling) leads to rationing and death to the elderly. The facts flatly contradict that lie. There is no evidence that they do, rather the facts suggest, though do not prove, just the opposite.

A final note: since I have been flogging comparative effectiveness analysis, some may wonder if I have a personal interest in drumming up business, since I am in the healthcare biz. I hate doing cost-effectiveness analysis; they are long, boring, complicated, and very exacting projects. I have done my share and hope to never have to do another, unless I find one that I think is interesting (but I doubt it).

Second, anyone in the healthcare knows that US medicine runs on comparative effectiveness analysis, even though many will deny it. Get on Google scholar or PubMed and type in "cost effectiveness" (over twenty thousand articles) or “comparative effectiveness” (hundreds). Many of these studies are financed by industry in order to persuade insurers, doctors and hospitals and clinics to use their drugs and other products. The problem is that the quality of these studies is difficult to evaluate. Since they are widely used in the US anyway to determine whether a drug should be used, it would be better to have more public input and examination of how they are done. It would be better to establish which studies are reliable, and disseminate that information, rather than allow industry studies of uncertain qaulity to influence medical practice.

Sources

Banta H and Wit G. Public health services and cost-effectiveness analysis. Annu. Rev. Public Health 2008. 29:383–97.

Do comparative effectiveness programs cause elder genocide? Shocking Results
By: wesgpc Wednesday July 29, 2009
http://seminal.firedoglake.com/diary/6766

Gress S, Niebuhr D, Rothgang H and Wasem J Criteria and procedures for determining
benefit packages in health care: A comparative perspective. Health Policy 73 (2005) 78–91

OECD Health Statistics 2009.
http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html

Switzerland. OECD Reviews of health systems. OECD and the World Health Organization. 2006.

Switzerland. Health Care Systems in Transition report. European Health Observatory on Health Care Systems. World Health Organization Europe. 2000.