Swiss vote rejects single health insurer plan

Swiss voters have overwhelmingly rejected a proposal for a single health insurer. In the March 11 ballot, 71% of voters were against the proposal to establish one state-run insurer to replace the 87 that now write the coverage. Voting against the proposal was heaviest in the German-speaking part of the country with opposition lighter in the French and Italian-speaking regions.

The initiative made it onto the ballot after the left-leaning Mouvement Populaire des Familles collected 110,000 signatures to force the vote. The group claimed the current system is too costly and wanted it replaced by a single insurer that would base premiums on wealth and income. Health insurance is mandatory for Swiss residents.

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Australia: Another State health system in trouble

The boss of Tasmania's massive Health and Human Services department has quit, halfway through a series of major and "difficult" reforms. DHHS secretary Martyn Forrest yesterday announced his resignation, saying he had accepted an education position in the Middle East.

In the past few years there has been an exodus of senior bureaucrats and medical specialists from the department, which Health Minister Lara Giddings admits is stretched to the limit. Dr Forrest's departure comes as the DHHS is going through budget cuts and unprecedented change and all services -- including public hospitals -- are under review. A new Royal Hobart Hospital is being planned, the swamped child protection system is in the midst of an overhaul and there are fears of hospital closures in the North-West.

Dr Forrest said there was never a good time to leave. He admitted the job had been challenging and stressful and the department had been "in a bit of a moribund state, a bit depressed" when he took charge in late 2005. "Now I think that it has got a bit of confidence about what it is doing," he said.

Ms Giddings admitted Dr Forrest's departure could lead to "very short delays" in the clinical services and primary health services plan. But the State Government was committed to reform to prepare for increased future demands. And she defended the departure of Dr Forrest and other key DHHS people as "nothing out of the ordinary for a workplace of more than 11,000 people". The RHH churned through four CEOs in little more than a year and security marched emergency department head Alastair Meyer out of his office last April. Other resignations include:

-- Children's Commissioner David Fanning, who quit in September saying the system was not coping, and still has not been replaced.

-- DHHS deputy secretary Anne Brand quit last March, telling Dr Forrest it was "time to move on".

-- Alcohol and Drug Service clinical director David Jackson quit last February, saying he could no longer watch young people die of drug addiction.

-- RHH head of obstetrics and gynaecology Melwyn D'Mello resigned just before the election was called last February.

-- And hospital CEO Ted Rayment was deposed under a shroud of mystery in August 2005.

Australian Medical Association southern division chairman Haydn Walters said Dr Forrest had overseen a period when politics, not clinical need, had driven spending. Prof Walters said Ms Giddings now had a good opportunity to appoint someone with experience in health -- which he said Dr Forrest lacked -- to spend money sensibly. "Find somebody who wants to work with the doctors and nurses rather than treat them like the enemy because they spend money," he said.

Australian Nursing Federation state secretary Neroli Ellis said Dr Forrest had replaced senior nurses with bureaucrats from the Education Department. Dr Forrest was head of the Education Department from 1997 until October 2005, when he moved to the DHHS to replace John Ramsay. "ANF has serious concerns with the legacy he has left behind," Ms Ellis said, adding many of the bureaucrats were on five-year contracts.

State Opposition health spokesman Brett Whiteley said Dr Forrest had been an impeccable public servant and his departure was a "major blow". Mr Whiteley said the health system had been in "meltdown" under Labor and delays in vital reforms were expected. Dr Forrest said the Fit program to cut red tape in the bureaucracy had been his major achievement during his 17-month term. Ms Giddings thanked Dr Forrest for his leadership and initiating reforms and said his departure should not hurt the department.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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