OVERVIEW OF SWITZERLAND’S NATIONAL HEALTHCARE SYSTEM

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2017):
Public Coverage: %; Primary Private Health Coverage: 100%; Total: 100%

Note: “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 (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Out-Of-Pocket Spending As Share Of Final Household Consumption, 2017: 6.9%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-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.

“The system is characterized by the sharing (and some would say fragmentation) of decision-making powers between: (1) three different levels of government (the Confederation, the 26 cantons and the 2352 municipalities); (2) legitimized civil society organizations (so-called corporatist bodies) of – amongst others – mandatory health insurance (MHI) companies and providers; and (3) the people who can veto or demand reform through public referenda.

“The Confederation (or federal level) can act only in areas in which the constitution has granted it explicit power to do so. The most important areas of legislative responsibility of the Confederation (as defined by the constitution) include: (1) the financing of the health system (MHI and other social insurance); (2) the quality and safety of pharmaceuticals and medical devices; (3) public health (control of infectious diseases, food safety, some parts of health promotion); and (4) research and training (tertiary education, training of non-physician health professionals). The most important law, defining the legal framework of the MHI system is the Federal Health Insurance Law (KVG/LAMal).

“The cantons are responsible for securing health care provision for their populations and this right is often codified in cantonal constitutions. They are also in charge of issuing and implementing a large proportion of health-related legislation. In addition, the cantons finance an important share of inpatient care; provide subsidies to low-income households enabling them to pay for insurance, and coordinate prevention and health promotion activities. The role and influence of municipalities in providing health care services and other social support services varies across Switzerland and depends on decisions within each canton.”

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 [Total Health Expenditure] (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.

“The cornerstone of health financing is mandatory health insurance operated by private insurers on a non-profitmaking basis. This is comprehensive, covering a broad range of essential interventions listed in a catalogue that is continuously updated by the health authorities, including alternative treatments such as acupuncture or homeopathy. The main exclusions are dental care and nursing home stays. Individuals are entitled to state-financed premium subsidies if their expenditure on mandatory coverage exceeds a certain percentage of taxable income and wealth (in 2009, 30% of population was eligible; Federal Office of Public Health, 2012). Inpatient care is jointly financed on an approximately 46–54% basis by mandatory coverage and direct transfers from the federal government and local government (cantons). Before 2011, subsidies for inpatient hospital care were only paid for hospital stays within the canton of residency, but this rule was abolished in a health reform in 2012.”

Source: Viktor von Wyl and Konstantin Beck. “Switzerland.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Sept. 21, 2021 by Doug McVay, Editor.