As the United States resumes debate over options for achieving universal health coverage, policymakers are once again examining insurance systems in other industrialized countries. More recent attention has focused on countries that combine universal coverage with private insurance and regulated market competition. Switzerland and the Netherlands, in particular, have drawn attention for their use of individual mandates combined with public oversight of insurance markets. This paper provides an overview of the Swiss and Dutch insurance systems, which embody some of the same concepts that have guided health reforms adopted in Massachusetts and considered by other states and by federal policymakers. The two systems have many features in common: an individual mandate, standardized basic benefits, a tightly regulated insurance market, and funding schemes that make coverage affordable for lowand middle-income families. Differences include degree of centralization, basis of competition among insurers, availability of managed care, and reliance on patient cost-sharing to influence care-seeking behavior. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This and other fund publications are available online at www.commonwealthfund.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1220.

Bezieher von Sozialleistungen, die eine Arbeit annehmen, verlieren oft im gleichen Umfang oder sogar vollstandig den Anspruch auf staatliche Unterstutzung. Fehlanreize gehen auch vom Steuersystem aus. Bedarfsleistungen, also Leistungen, die nur im individuellen Bedarfsfall erbracht werden, sind haufig von der Steuerpflicht ausgenommen. Bei steigendem Erwerbseinkommen hingegen erhohen sich die Steuern nicht selten mehr als das Gesamteinkommen. Damit sind die Anreize fur Transferempfanger negativ, sich von der Abhangigkeit zu losen und eine Erwerbstatigkeit aufzunehmen oder den Erwerbsumfang zu erhohen. Negative Folgen dieses Systems sind eine andauernde Arbeitslosigkeit, die Dequalifikation und Desintegration der Arbeitslosen und damit eine schwindende Vermittlungsmoglichkeit von Erwerbslosen auf dem Arbeitsmarkt. Seit den Achtzigerjahren versucht eine Reihe von Industrielandern, die beschriebenen Probleme mit erwerbsabhangigen Steuergutschriften in den Griff zu bekommen. Dabei wird den Haushalten, deren Einkommen unter einer bestimmten Grenze liegt, ein Teil ihrer Steuerschuld erlassen. Dies geschieht in Form einer Steuergutschrift. Unter den zwolf Landern, die 2002 uber dieses Instrument verfugten, befinden sich neben Grossbritannien, Kanada und den USA auch die Niederlande, Belgien, Finnland, Irland und Frankreich. Anfang 2005 beauftragte der Bundesrat eine Expertengruppe mit der Abklarung, ob dieses Instrument auch in der Schweiz geeignet sein konnte, Arbeitsanreize zu verbessern, die Arbeitslosigkeit zu reduzieren und das Beschaftigungsvolumen im unteren Einkommensbereich anzuheben.

2008, Vol. 144 (2) 247–282 a Lucerne University of Applied Sciences And Arts, Institute of Financial Services Zug IFZ. b Foundation Swiss School of Public Healthplus, Zurich. c Corresponding address: Gabrielle Wanzenried, Lucerne University of Applied Sciences and Arts, Institute of Financial Services Zug IFZ, Grafenauweg 10, CH-6304 Zug, Switzerland; phone: "$"41 (0)41 724 65 64, email: gabrielle.wanzenried@hslu.ch. We would like to thank Mike Gerfin, Bronwyn H. Hall, Robert E. Leu, Markus König, Heather Murray, Heidi Seney, Roland Unternährer, participants of the EARIE Conference 2002, Madrid, the World Congress of the International Health Economics Association 2003, San Francisco, and the annual conference of the Verein für Socialpolitik 2005 in Bonn and an anonymous referee for helpful suggestions and comments and the Swiss Federal Statistical Office for data provision. Gabrielle Wanzenried acknowledges financial support of the Swiss National Science Foundation. All errors are our sole responsibility. The Evolution of Physician Density in Switzerland

A couple of years ago, images of the «Needle Park» in Zurich went around the world. Partly because of the harm becoming visible, partly also because of AIDS, the Swiss heroin policy changed dramatically and became one of the most liberal. In addition to existing policy measures, namely repression and abstinent oriented therapies, the conditions for entering methadone programs were substantially lowered, and a whole series of measures to reduce harm directly and quickly were installed. Most attention of all new measures received «The Swiss Heroin Project». Beginning in 1994, 1000 heavily addicted users got narcotics from the state. The project phase was running until the end of 1996. The project was scientifically accompanied and the results were published lately (see UCHTENHAGEN et al ( 1997) and FREI et al ( 1997)). At the end of February 1998 the Swiss government decided to institutionalize heroin treatment as a legal therapy. My aim is to examine the Swiss heroin policy from an economist's point of view. I will start by investigating the subject theoretically. The question will be: How does a rational heroin policy look like? Next, I will discuss prohibition as a policy tool. Here, the question will be: Does prohibition work, namely does it lead to a reduction in consumption of heroin? This question, too, will be analyzed theoretically. After describing it, and armed with the theoretical background, I will investigate the Swiss heroin policy. The question I will answer is: How does the Swiss heroin policy fare relative to the derived optimal policy? The result will be that the Swiss heroin policy still puts too much weight on prohibition.

Income support for working low-income families (the 'working poor') is on top of the political agenda in Switzerland. The current social assistance system is considered inadequate to support working poor households. Several European countries have introduced in-work benefits in order to make work pay. Based on a structural labour supply model, this paper provides microsimulation results of the effects of introducing different schemes of in-work benefits. It turns out that adding a minimum hours requirement to the current social assistance system is the most cost-effective reform. One-third of expected costs can be attributed to behavioural changes in labour supply.

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996.

Income support for working low income families (the "working poor") is on top of the political agenda in Switzerland. The current social assistance system is considered inadequate to support working poor households. Labour unions propose the introduction of a general minimum wage, whereas the Swiss government promotes in-work benefits. Based on a structural labour supply model this paper provides microsimulation results of the effects of introducing different schemes of in-work benefits. It turns out that adding a minimum hours requirement to the current social assistance system is the most cost-efficient reform. Minimum wages are ineffective in fighting poverty.

Berufliche Weiterbildung spielt in der modernen Arbeitswelt eine zentrale Rolle bei der Entwicklung der beruflichen Fahigkeiten von Arbeitnehmern und hat daher potentiell grosse Auswirkungen auf deren Chancen im Arbeitsmarkt. Die vorliegende Arbeit bietet eine deskriptive Analyse des Weiterbildungsverhaltens in der Schweiz und untersucht anhand okonometrischer Schatzungen die Auswirkungen beruflicher Weiterbildung auf die Lohne der Arbeitnehmer. Die dazu verwendeten Daten stammen von den Befragungswellen 98, 99 und 2000 der Schweizerischen Arbeitskrafteerhebung (SAKE). Da davon auszugehen ist, dass die Teilnahme an beruflicher Weiterbildung nicht zufallig, sondern Ergebnis rationaler Entscheidungen von Arbeitgebern und Arbeitnehmern ist, kann Weiterbildung nicht als eine exogene Determinante des Lohnes betrachtet werden. Eine Schatzung der Mincer Lohngleichung mittels OLS fuhrt daher zu verzerrten Schatzern. Zur Entscharfung des Endogenitatsproblems wird in dieser Arbeit ein Fixed effects Modell verwendet. Die Schatzergebnisse implizieren eine Weiterbildungsrendite von ungefahr 2%, was deutlich tiefer ist als die bisher fur die Schweiz vorliegenden Schatzungen.