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Population Insurance Coverage For A Core Set Of Healthcare Services (%), 2019:
Public Coverage: 0%; Primary Private Health Coverage: 100%; Total: 100%
*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“Switzerland ensures access to health care through a system of MHI [Mandatory Health Insurance], which has been compulsory for all residents since 1996 (although some cantons had compulsory insurance as early as 1914). Citizens who want to purchase MHI cannot be turned down by insurers, and cantons provide subsidies for people on low incomes (although the nature and level of these vary widely by canton). The standard benefits package is regulated by federal legislation and includes most general practitioner (GP) and specialist services, as well as inpatient care and services provided by other health professionals if prescribed by a physician.”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
“All permanent residents are legally obliged to obtain coverage by purchasing an MHI [Mandatory Health Insurance] policy. Cantons are responsible for the enforcement of the law and they have to subsidize insurance premiums for persons who would otherwise be unable to pay their premiums. Individuals who refuse to take out MHI are assigned to an MHI company by the cantonal authority.
“Since 2012, if individuals fail to pay their premiums, MHI companies can request cantons to pay 85% of the unpaid premiums and other debts (as identified by MHI companies) on behalf of the insured. This change was introduced to ensure that all residents have valid insurance coverage and can receive care. However, cantons can make lists of individuals with arrears, which are sent to public (cantonal) providers, and MHI companies will reimburse only emergency care provided to blacklisted patients. According to data of the FOPH (2014k), more than 100 000 people had arrears on their premiums in 2013, a number that had increased by around 10% every year in the past. Once insured defaulters have repaid their debts, full coverage is provided again, and MHI companies have to reimburse 50% of the repaid debts to cantons.
“New residents are obliged to obtain insurance within three months of their arrival in Switzerland, which is then applied retroactively to the date of arrival. Since only individuals with valid residence of more than three months can take out MHI policies, the problem of undocumented immigrants remains unresolved (see section 5.14). However, in general, non-Swiss citizens are always treated in an emergency; the issue of who pays for the service only arises afterwards. If a resident of an EU country needs medical care in Switzerland, care is reimbursed according to EU regulations and agreements (see section 2.9.6).”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
“All members of MHI have access to a standard benefits package. The content of the package is broadly defined by the KVG/LAMal as those services that are necessary for the diagnosis or treatment of a disease and its consequences as well as maternity services, on condition that these services are effective, appropriate and cost-effective (Art. 32 KVG/LAMal). Accidents are also covered under MHI except if individuals opt out because they are already covered under mandatory accident insurance (UV/AA) (see section 3.6). The exact content of the benefits package is specified by the federal government in several explicit positive and negative lists (see section 2.8.1).
“In practice, MHI covers most GP, chiropractor, midwife and specialist services, as well as inpatient care and an extensive list of pharmaceuticals, medical devices for home use by patients, laboratory tests and physiotherapy, speech therapy, nutritional counselling, diabetes counselling, outpatient care by nurses and occupational therapy (if prescribed by a physician). A contribution for costs of transport or rescue is paid. Psychotherapy services of non-medical professionals (e.g. psychologists) are covered only if prescribed by a qualified specialist and provided to patients in the specialist’s practice. Long-term care is covered only if it is ‘medically necessary’. Dental care is covered only if it concerns a serious non-preventable illness of the masticatory system (e.g. maxillofacial cancers) or if it is related to care for other diseases (e.g. leukemia or AIDS). Some prevention and screening measures are covered on the basis of a positive list, which includes pap smears, HIV tests, colonoscopies, mammography screening, genetic counselling and selected vaccinations.
“MHI coverage gives preference to services provided in the canton of residence. However, in case of medical need, MHI also covers outpatient and inpatient services provided in a canton other than that of residence. In 2012, the territorial clause for inpatient services (use hospitals inside the canton) for inpatient acute care services was abolished. Since then, patients are free to choose their preferred hospitals in other cantons as well, but may have to pay the difference between the costs in the canton of treatment and those that would have been reimbursed in their canton of residence (see sections 3.7 and 5.4.2). Therefore, residents continue to purchase VHI for nationwide coverage of inpatient care.”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
“All residents in Switzerland have to purchase health insurance from competing MHI [Mandatory Health Insurance] companies. Persons who want to purchase MHI cannot be turned down by insurers. Premiums are community-rated, i.e. they are the same for every person insured with a particular company within a region independent of gender or health status but varying for three age categories (see section 3.3.2). Since 1996, insurers are private companies competing for market share although they are not allowed to make a profit from their MHI activities. In 2012, MHI paid for about 35.8% of THE (see section 3.2), while the cantons (the second most important payer) contributed 17.2% of THE.
“The benefits of MHI, prices of pharmaceuticals, and certain national quality and safety standards are defined by the Confederation. However, corporatist actors, in particular associations of MHI companies (santésuisse, curafutura and RVK – the association of small and medium insurers) and associations of providers (physicians, hospitals, medical homes, etc.) also play an important role. They are charged with determining tariffs for the reimbursement of services; they negotiate contracts; and they may control and sanction their members at the cantonal level. If corporatist actors fail to reach an agreement, the Confederation or cantons may intervene and define tariffs or set standards themselves.”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
“MHI [Mandatory Health Insurance] is the most important payer in the health system (see section 3.2). Since the introduction of KVG/LAMal, all statutory health insurers have become private companies. MHI companies must accept all citizens who are willing to purchase insurance with the company and they are not allowed to make a profit from their MHI activities. In 2014, there were 61 insurance companies that offered MHI policies in Switzerland. This represents a considerable decline in number, when compared to roughly 100 companies who offered MHI in 2000 (FOPH, 2014k).”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
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Page last updated Jan. 30, 2023 by Doug McVay, Editor.
