My Experience With The Swiss Healthcare System As An Expat

“Frau Oh, it is highly unusual that we run this many tests on somebody and don’t find something seriously wrong with them”, my Swiss doctor announced dryly from beneath his bushy grey eyebrows. I could never tell whether Doctor G was kidding or serious and unlucky for me, he liked to amuse himself by playing a little game we call, mess with the foreigner who is ill and desperate enough to believe just about anything you tell her right now.

Like most of our appointments, it was conducted informally. Dr. G didn’t wear a white jacket and had never once washed his hands or snapped on a pair of latex gloves before examining me. We were seated in two leatherback chairs in his office, a thoroughly un-sterile environment as far as this girl who was used to antiseptic American medicine was concerned. The walls around us were crowded with bookshelves hosting medical volumes, self-help tomes, portraits of Dr. G skydiving and a giant neon plaque bearing the message, “Trust me, I’m a doctor.”

When I’d come in earlier that year complaining of gastro distress, Doctor G performed an ultrasound on me in that very same office. Instead of leaving and asking me to change into a hospital gown, he casually suggested I yank up my sweater so he could run the wand over my abdomen and then to my horror loudly joked about selling my organs on the black market.

Dr. G is definitely a bit of a loose cannon when it comes to medicine but he is indicative of a healthcare system that is more personal, direct and informal than the American system I was used to. The Swiss healthcare system was a little disconcerting to me at first but honestly, now that I’m used to it, I’ve come to prefer the more casual approach. What is a typical doctor’s visit like in Switzerland? Will my Swiss doctor speak English? How does the Swiss insurance system work? And here’s a burning question you were probably too embarrassed to ask: What’s it like going to the gynecologist in Switzerland? Well, lucky for you, I have zero shame, so I’m about to explain it all to you. Read on for the real deal on Swiss Healthcare!

First Of All, It Ain’t Socialized Medicine

“You’re so lucky you live in a place with universal healthcare!” I lost count of the times I heard this from my American friends. Americans tend to think that I live in the United States of Europe and that ALL European countries have a FREE taxpayer-supported medical system that functions like Britain’s NHS. Erhhhm, not quite. In reality, every country functions differently and very few European countries have full-on single payer healthcare like the UK. Healthcare in Switzerland is compulsory, private, and costs a pretty penny.

How Does It Work?

Relax, it’s not rocket science.

Swiss healthcare is run by a series of non-governmental non-profits. There’s a wide range of options out there from high deductible plans for the young and healthy to more expensive ones that include coverage for things like gym visits and massage.

American friends beware, there’s no such thing as a co-pay here. Up to the deductible, the patient pays for every single cent of every doctor’s visit, even for preventative things like your yearly checkup and pelvic exam. That’s right, after seeing a Swiss doctor you’ll get one of those dreaded orange slips in the mail, charging you for every poke, prod, test, x-ray and consult you get at the doctor’s. One doctor even billed me for the time he spent responding to my emails. And get this: because I am a woman of child-bearing age, they are allowed to charge me more money for my health insurance! Never mind that I never plan on squeezing out a brat or two!

On the bright side, the cost of prescription drugs in Switzerland nowhere near as outrageous as I found it to be in the U.S. Because of the way the law works in here it is illegal to sell generic drugs. So Swiss doctors issue patients name-brand version of drugs that somehow, miraculously, cost roughly the same as generics do in the United States. I don’t know how they do it, but they do.

You’ll also have accident insurance, which in my case is provided by my employer. This covers you for medical costs that aren’t your fault, like getting injured in a car accident, or like that time I nearly had my face bitten off by a dog! Be sure to keep your accident insurance card in your wallet at all times and present it at the emergency room if you wind up being hospitalized for a freak occurrance. Your medical care for accidents should be completely covered!

The Swiss are insured to the teeth, literally. There’s no such thing as dental care for folks over the age of eighteen. Apparently adult teeth are supposed to be invincible? Folks in Switzerland pay out of pocket for yearly cleanings. Procedures like fillings will cost you a pretty penny and nope, not a penny of it is covered. What if it’s something more serious? Hopefully, you got all your dental work before you came here, or you alternatively don’t mind a little dental tourism to Germany or Eastern Europe. I time my dental appointments to coincide with my visits home to the states.

My advice for any expat about to buy into the Swiss insurance system is to do some comparison shopping on comparis.ch and pick the most inexpensive plan that makes sense. I picked a plan that was a bit more expensive because I thought it would cover me for more things, but I was wrong, it didn’t. So I might as well have chosen the rinky-dink plan and saved some cash! The few hundred Francs I get back for my gym membership each year doesn’t come anywhere near to canceling out the extra I pay in my monthly premiums.

Will My Doctor Speak English?

When it comes to your health, don’t ever feel embarrassed to ask!

They almost certainly will. You should have very little problem expressing your health concerns to a Swiss doctor. Many of them have done their advanced degrees in English. If you are concerned, bring a trusty phrase book with some keywords bookmarked, use Google translate, and don’t be afraid to point, use body language and make sound effects! But in all seriousness, your Swiss doctor will probably have a high level of proficiency in English and be comfortable speaking it with you.

What is trickier is that the nurses and front desk staff may have very limited English capability. That means making an appointment will be a struggle until you learn more German. Shift your language learning goals to be able to do this independently and you will be a happier expat. One of my first big German goals was to be able to make a doctor’s appointment over the phone all by myself. Once I mastered this it was a huge load off of my mind.

Getting what you want out of language learning can be tricky. Check out how I did it here!

It Really Is Efficient

The nice thing about the Swiss Healthcare system is that once you pay into it, it’s accessible and convenient. Unlike in America, there is no notion of a doctor being “in network or out of network”, if you need to see a specialist your doctor sends you to the best one, regardless of which medical institution she or he operates out of. No red tape whatsoever.

There are very few areas of Switzerland where one can get almost immediate gratification, but your doctor’s office is one of them. When you are sick it is usual for your doctor to send you home with a goodie bag of medications, no need to truck it to the pharmacy and wait in line for a prescription to be filled. When I jacked up my back my chiropractor read my X-ray results back to me in a matter of minutes.

Swiss punctuality is alive in the medical world as well. I can usually see my primary care physician within a day or two of calling, same day if I call and tell them I’m really ill. Except for in the case of my disastrous sleep study (more on that later), I’ve managed to get in to see specialists within days or weeks too. For more serious things like tests, instead of letting you pick an appointment the hospital may issue you a letter with a date and time to appear, but your workplace will take that letter seriously and you will be released to go no questions asked!

You Are Not A Number

I had so many horrible experiences being ignored, overridden and talked down to in the American health system. My primary care physician in Boston had thousands of patients to tend to and less than five minutes to spend with each patient. She’d rush in and out, half-listen, then insist on hastily writing me a script to get me out of her hair. And if there were side effects? Follow up questions? Forget it. I had to navigate a maze of answering machine prompts out of a Kafka novel just to leave a voicemail for a nurse practitioner, who maybe, just maybe if you called them back a half-dozen times during business hours (but not during their 1.5 hour lunch, when you couldn’t even leave a message!) they’d get back to you. As a result of this, I feel like I waited years to get partial answers to my health problems and there was nobody, nobody connecting the dots or looking at the big picture. All of this changed when I moved to Switzerland.

To me, the big difference in Switzerland is how personal the healthcare is. My doctor now spends an average of ten to fifteen minutes per visit with me, this is the medical doctor I’m talking about, not a nurse or an intern! They listen, emphasize, ask questions and follow-up with me. If I go in for a test they don’t just send me a letter with my results, they invite me back to their office to have a proper chat about it. And if the desired results aren’t achieved, they follow up and don’t give up until I’m healthy again!

You’d Better Get Over Your Prudery Now

I knew Europeans were more comfortable with their bodies than Americans and far more than any mixed-gender nude sauna (yes, it’s a real thing, and I lasted about 5 minutes in one before it got too weird) my experience in the Swiss healthcare system really drove this idea home.

Everything about the human body isn’t medicalized, sterilized and depersonalized in Switzerland the way it is in the U.S. This can lead to a more holistic and less anxiety-ridden healthcare experience but it involves throwing some notions about what is appropriate out the window.

For those of you who have a uterus, I have one sage piece of advice when it comes to having a pelvic exam…wear a dress. That is, unless you’re cool swanning around the examination room naked from the waist down except for your Keds sneakers trying to casually shoot the shit with your doctor. Yes, this happened to me at my first Swiss pelvic exam because I had no idea what to expect and showed up wearing jeans and a T-shirt. Had I been wearing a dress I’d have spared myself that awkward (and slightly chilly) sashay to the examination table.

Here’s how a gynecologist office visit is likely to go in Switzerland: First, you’ll be invited into the office, where you’ll sit at your doctor’s desk and discuss your health with them. Please, for the love of Maude, try not to laugh out loud at the way they pronounce the word, “vagina”.

After the consult, you and your doctor will repair to the adjacent examination room. Unlike in the States, where they will then likely leave you in the room to change into a hospital gown and swaddle yourself in a few cubic tons of tissue paper, your Swiss doctor will invite you to change in a small cabin in the room while they wait right there. But there will be no hospital gown in that little cabin, and no tissue paper to cocoon yourself in once you reach the exam table (Which is more like a giant easy chair!). Why? Because the Swiss see all the laundry they’d have to do just to preserve each patient’s “dignity” as wasteful. That, and the human body is genuinely, no big deal. We’ve all got one, right?

Now that I’ve gotten used to it this way, I prefer it. I’m not ashamed of my body and I like being able to see what’s going on during my exam. It should be said that although the human body is out in the open during a Swiss medical visit, you should expect your doctor to handle you with respect. Casual or unwanted touch is not part of the deal so don’t be afraid to speak up if you don’t like how somebody is treating your body!

Stress Is Considered A Serious Disease

Admit it, you’re not. Time to do something about your stress levels, m’kay?

Allow us to flash back to the beginning of this post, where I sat in Dr. G’s office anxiously awaiting the results of a litany of tests.

At this point in my expat career, I was about six months deep in a hellish fever dream come to life of shitty health. It started out slow with constant low-grade sinus infections and developed into debilitating asthma. Yes, I developed asthma living in one of the cleanest countries on the planet. Don’t ask me how I managed that one. Things gradually got worse and worse, and I ended up suffering from a rabid case of insomnia that was slowly but surely strangling my will to live. I would wake suddenly from my sleep several times each night, often gasping for breath. I was sure there was something horribly wrong with me.

Dr. G referred me to a sleep specialist, who took months to see me. He sent me home with a home sleep study kit which I was sure would be the answer to all of my problems. I wanted a diagnosis, damn it! I wanted some medication. I was so desperate to get a good night’s sleep I would have been relieved with a sleep apnea diagnosis, even if it meant wearing the Darth Vadar mask thing to bed every night for the rest of my natural life. Such was my thirst for relief from the nightmare of insomnia.

I was not prepared for what happened next.

Like with most diagnosis in Switzerland, instead of writing me a letter, I was summoned back to the specialist’s office. He told me the results of my test were inconclusive. Then he asked me a curious question:

“Do you work 100%?”

“Uuuhm, yes?” I replied.

“Well you really should try to work less than that. How about 80%? Stress is a killer, you know.”

And there it was, the old Swiss adage, Stress is A Killer. I’d had it repeated to me by at least three doctors in my tenure here. The Swiss take stress seriously as an ailment. A Swiss doctor will prescribe you a day at the spa for everything from back pain to insomnia. They believe deeply that having a healthy work life balance is the cure to most of life’s problems. When I explained that working less was definitely not an option, the specialist sent me home with the name of an herbal over the counter sleep-aid that I could get at any Swiss drug store and a suggestion to, “Go to the lake, go for a walk in the evening and avoid stress!”

I crumpled the herbal “prescription” and chucked it in the bin on my way out.

The Swiss way of dealing with my health challenges was totally foreign to me. Hadn’t I wanted to get away from being patted on the head and written a prescription? But when it came down to it, the American in me believed that the Swiss way of dealing with health was a fairy tale. I stomped back to Dr. G’s and requested more tests. When it came down to it, he raised his furry eyebrows to me and told me the same thing, “You need to avoid stress.”

The man who had once joked with me about selling my organs on the black market was not joking anymore! He was not about to make like an American doctor and bust out the big pharma guns for my sleep problems. There was only one thing to do. I had to listen to him and reduce my stress.

So what did I do? I engaged in a complete life overhaul. I changed my diet. I cut out things I used to love; booze, coffee, dairy, gluten, sugar, soy, nuts, nightshades, the list goes on. After decades of being a vegetarian, I incorporated meat back into my diet, because after cutting out everything else I loved there was nothing else to eat. That’s how desperate I was to feel better. I took to daily journaling and meditation. I started to prioritize my health, particularly sleep, above everything else.

It didn’t happen overnight, but slowly and surely the insomnia began to loosen it’s strangling grip on my life. I felt healthier and more vibrant than I had in ages. My skin began to glow, and people noticed. I lost weight, my energy skyrocketed and my sinus problems and asthma disappeared too. For the first winter in my entire teaching career I did not catch a single cold. If you work in the education field, you understand that’s basically a miracle.

There’s been a lot of good things that have happened to me whilst living in Switzerland. I have met incredible people, travelled to amazing places and loved my career. The best thing that’s probably happened to me though? Being forced to learn how to take care of myself.

Remember that time I pushed myself too hard and spent half my holiday in Nice in bed? Here’s how I handle travel setbacks and practice self-care on the road.

The Swiss Believe in Perfect Health

The Swiss consider The Great Outdoors to be preventative medicine, and with views like this can you blame them?

I like to tease the Swiss for being perfectionists, but when it comes to health, they’ve got the right idea. A typical Swiss person both works hard and plays hard. They take health, stress relief and leisure time as seriously as they take their professions. The Swiss mentality is that people are capable of enjoying life to the fullest at all ages and stages, so there is no excuse not to. Even the elderly here are super-active. I’ve lost count of the times I’ve been smoked on a hiking trail by a couple of grey-haired pensioners with walking sticks!

As a result, this uptight, overly-formal rule loving society is actually way less stressed out than their supposedly cool and casual American counterparts. Americans see stress as a sign that we’re doing something right in our professional lives. We build our lives around work and then fit self-care, friends and family into the scraps of unused time that our careers haven’t yet managed to pillage. I was thoroughly in that mindset when I moved here, so I wasn’t listening to my body when it threw asthma, sinus infections and insomnia at me as a message to say would you please calm the F down!? Because Swiss culture supports and prioritizes self-care, I was able to find a non-medical solution to my illness. I may have no idea where I’m going from here, but I can guarantee you I’ll be taking this lesson with me!

What about you? Are there any health lessons you’ve learned abroad and brought back home with you?