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HEALTH

EXPLAINED: Why Switzerland avoided adding French border regions to its quarantine list

Switzerland on Monday added several regions of France and Austria to its quarantine list, but avoided including border regions. Here’s why.

EXPLAINED: Why Switzerland avoided adding French border regions to its quarantine list
The river La Morge in Saint-Gingolph, a natural border between Switzerland and France. Photo: FABRICE COFFRINI / AFP

Switzerland put in place a mandatory, ten-day quarantine on arrivals from certain ‘high-risk’ countries in early July. 

While until mid-September, none of these countries shared a border with Switzerland, rising infection rates in neighbouring France and Austria forced authorities to make a call they hadn't made with the dozens of other countries on the list. 

Authorities broke France and Austria up into regions, with Swiss Health Minister Alain Berset implying that border regions would not be placed on the list regardless of infection rates due to economic and social ties. 

READ: How Switzerland avoided a coronavirus 'catastrophe' by protecting cross-border workers 

The government said it was following the lead of other European nations that are already implementing “a region-based approach” to neighbouring countries.

“Taking a regional approach means that persons returning to Switzerland from risk areas will be required to go into quarantine, but not persons returning from regions on the Swiss border,” authorities said, adding that the decision takes “account of the close economic, social and cultural exchanges that take place in the border regions”.

Berset said the decision to avoid placing border areas under quarantine reflected the need to show 'pragmatism, proportionality, modesty' in decision making. 

'No intention of shutting down the economy'

Berset told a news conference Friday that the government had decided to place nine of 13 French regions, including Paris, on its at-risk list, as well as Vienna in neighbouring Austria.

“We have seen a number of new infections in France, which are today already higher that the numbers in March and April,” he said, stressing that “this is a situation to take seriously… We're trying to keep the pandemic under control.”

EXPLAINED: Which countries quarantine travellers from France?

At the same time, he said, the government had sought a “pragmatic” approach and thus exempted the border regions in France and other neighbouring countries from the order, set to take effect from Monday.

“The idea is to preserve life along the borders where people live and work,” he said, pointing to heavy cross-border trade, as well as the many people who live on one side of the border but work on the other.

To define a risk area, Switzerland has set a limit of more than 60 coronavirus infections per 100,000 inhabitants in the last 14 days.

In the nine French regions, as well as in Vienna, this number is exceeded, meeting the Swiss criteria for a risk country.

READ MORE: UPDATED: Everything you need to know about Switzerland's quarantine requirement

However, Berset said that regions of France and Austria bordering Switzerland will not be added to the list, as local economies depend on the cross-border workers.

That is especially the case in the Lake Geneva region, which relies heavily on over 125,000 frontier workers from France.

“We have no intention of letting entire swathes of our economy to shut down”, Antonio Hodgers, president of the Geneva Council of State told Tribune de Genéve. 

In Geneva, some 60 percent of the city's health workers live in France.

The government also added France’s overseas territories to the countries at risk, meaning that all travellers from those regions will have to self-quarantine as well.

'We are together, for better or worse'

President of the Geneva Council of State, Antonio Hodgers, welcomed the decision – saying it would ensure the region didn't suffer. 

“We are very satisfied with the device chosen because there will be no negative impact on our region” Hodgers told Le Temps

Jacques Gerber, Minister of the Economy and Health, agreed. 

“It is a pragmatic solution which makes it possible to keep the balance between the necessary health measures and the economic, cultural and social activity of our regions” he said. 

Hodgers said the decision was a reflection of the reality of the region's interconnected ties and that imposing a lockdown along an arbitrary border would be ineffective. 

“The French did not want to relive the suffering of this spring either. We are in the same living area, therefore in the same sanitary basin. We are together, for better or for worse, in a way.”

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HEALTH

How is Swiss healthcare system different from the rest of Europe?

Switzerland’s health infrastructure is consistently rated among the best in the world, but how does it compare with other countries?

How is Swiss healthcare system different from the rest of Europe?

Whether in terms of politics, social system or economy, the Swiss often chart their own course, which fundamentally diverges from that of its European neighbours.

Healthcare is no exception.

The differences lie primarily in who finances the scheme — public versus private — and how the overall system functions.

Like much of the European Union, Switzerland has a universal health system, which means everyone in the country is covered by insurance and has access to medical care.

In most countries, the government typically has control, to a lesser or greater extent, over funding, health insurance, and health providers.

In France, for instance, most healthcare costs are covered by the state healthcare system, known as assurance maladie, and this is funded by taxes – healthcare costs account for about 13 percent of the average person’s gross salary.

In Germany, health costs are shared by employers and workers, with employees paying 7.5 percent of their salaries into a public health insurance fund, and companies matching that amount.

Italy’s national, system, called the Servizio Sanitario Nazionale, or simply SSN, which is financed mainly though federal and regional taxes, automatically covers all residents. Medical care is largely free of charge at the point of service.

Public healthcare also exists in Austria, with certain portions of salaries being automatically deducted to fund the scheme. However, healthcare is free of charge for low-income people or those who who are disabled, studying, or retired.

Although no longer part of the EU, the UK health system is also based on state healthcare via the NHS. It is funded by taxes which account for about 4.5 percent of the average citizens’ gross income.

What about Switzerland?

The system here is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage and purchase it from one of dozens of private carriers.

Basic insurance — KVG in German and LaMal in French and Italian — is compulsory in Switzerland. It doesn’t come cheap — premiums are based on the canton of residence and age, costing 300 to 400 francs a month on average — but it is quite comprehensive; it includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

READ MORE: Everything you need to know about health insurance in Switzerland

There are no employer-sponsored or state-run insurance programmes, and the government’s only role is to ensure that all insurance companies offer the same basic coverage to everyone and that they have the same pricing.

While companies can’t compete on prices or benefits offered by the basic compulsory insurance — which are defined by the Health Ministry — they can, and do, compete on supplemental polices which offer perks not included in the basic coverage.

READ MORE: What isn’t covered by Switzerland’s compulsory health insurance?

All policies have deductibles (also called co-pays) that can range from 300 to 2,500 francs a year.

After the deductible is reached, 90 percent of all medical costs will be covered by insurance, with 10 percent being paid by the patient; however, this co-pay is capped at 700 francs a year for adults and 350 francs for children under 18.

The government does subsidise healthcare for the low-income individuals and households – defined as those for whom insurance premiums exceed 10 percent of their income.

What percentage of a person’s income goes to health insurance premiums?

This depends on wages and premiums, for instance, whether a person chose the cheapest option with a high deductible or the expensive one with a 300-franc deductible.

Generally speaking, however, based on the average monthly income of just over 7,000 francs, about 6.5 percent is spent on premiums.

What happens if you don’t take out an health insurance policy?

Anyone who arrives in  Switzerland must get insured within three months. If you don’t, the government will choose one for you and send you the bill. If this happens you may end up with more expensive premiums than you might have gotten if you shopped around yourself.

If you are still delinquent on your payments, your healthcare will be restricted to emergencies only; any other non-urgent medical treatment will be denied, unless you pay for it out of pocket.

The pros and cons of the Swiss system

Let’s look at the ‘cons’ first. Basically, there is one: the cost.

Not only are insurance premiums high and steadily increasing, but, at 7,179 francs per capita, Switzerland has the third most expensive healthcare scheme in the world — behind only the United States ($12,318) and Germany ($7,383).

Unlike taxpayer-funded models, there is no price grading according to income, so people on a low income pay a high proportion of their income for healthcare than higher earners. 

However, the system is generally efficient, has an extensive network of doctors, as well as well-equipped hospitals and clinics.

Patients are free to choose their own doctor and usually have unlimited access to specialists.

READ MORE: EXPLAINED: How to see a specialist doctor in Switzerland without a referral

Waiting lists for medical treatments are relatively short.

According to a survey by the Organisation  for Economic Cooperation and Development  (OECD) on how long patients in various countries typically wait for an appointment with a specialist, the share of people in Switzerland waiting a month or more is 23 percent, compared to 36 percent in France, 52 percent in Sweden, and 61 percent in Norway.

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