Switzerland: Political System - World Health Systems Facts

“Switzerland is a federal state in which government health responsibilities are split between the national, cantonal and municipal levels [1]. The federal level regulates areas such as financing (e.g. mandatory health insurance), the quality and safety of pharmaceuticals and medical devices, public health (e.g. control of infectious diseases), and education and training [2]. Each of the 26 cantons, with its own minister of health, is responsible for licensing its healthcare providers, regulating its hospital services and subsidizing its healthcare institutions (e.g. in-patient, homecare) [2]. Each canton can be considered to have a slightly different healthcare system [8]. The 2202 municipalities are mainly responsible for long-term care and social services [2]. Finally, thanks to its system of direct democracy, Swiss citizens are involved in shaping new laws or adjusting existing ones at all three levels, in addition to electing representatives [8]. These elements highlight the Swiss health system’s configuration of centralized and decentralized responsibilities for the building blocks of IC [9].

“In Switzerland, universal access to healthcare was established through a mandatory health insurance (MHI) introduced in 1994 [10]. Following a principle of managed competition allowing citizens a free choice of health insurers and providers, the MHI aims to i) strengthen solidarity between healthy and sick people, ii) ensure high-quality healthcare and iii) contain costs [11,12]. The basic MHI coverage includes a comprehensive package of benefits with direct and unrestricted access to healthcare services. However, around 70% of the Swiss population opt for a cheaper, alternative insurance model including gatekeeping [13]. The not-for-profit MHI scheme is operationalised by more than 50 insurers, which also operate for-profit complementary health schemes [2].

“In addition to MHI, healthcare services have other funding streams, such as out-of-pocket payments, direct and indirect public funding, and other social insurance schemes. These streams vary [14] between the numerous providers active in Switzerland. For instance, medical and non-medical providers of outpatient care are mainly reimbursed on a fee-for-service basis, and providers working in networks or health maintenance organisations (HMOs) are increasingly paid by salary and/or capitation [2]. These outpatient costs to the citizen are essentially covered by the MHI and out-of-pocket payments. On the contrary, inpatient care relies on a national diagnosis-related group (DRG) payment system [15], covered by both MHI and public funding. All health professionals are free to provide care and treatments that are covered by MHI. Except for some benchmarking used to monitor providers’ incomes (MHI law, art. 32 and 57), consistent and continuous quality controls have only recently emerged (e.g. patient outcomes [16]). Similarly, healthcare data transparency is still in its infancy [17].”

Source: Filliettaz SS, Berchtold P, Koch U, Peytremann-Bridevaux I. Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System. Int J Integr Care. 2021;21(4):10. Published 2021 Oct 29. doi:10.5334/ijic.5668

“Switzerland’s political system is special in so far as the lower levels of government, i.e. cantons and municipalities, have a very high degree of autonomy. Cantons are sovereign in all matters that have not specifically been designated by the Federal Constitution as the responsibility of the Confederation. In addition, the population is involved in the process of political decision-making more directly than in most other countries. Almost all federal, cantonal or municipal decisions of greater importance may be decided upon directly by the people.

“The Swiss Confederation is generally considered to consist of 26 cantons. However, some count only 23 cantons because six cantons are for historical reasons known as half-cantons, even though they have the same degree of autonomy as cantons. In addition, there are 2352 municipalities (since 2014) with considerable autonomy.”

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.

“Most proposals for reform are developed by the responsible department of the executive body (at the national level, the Federal Council). Subsequently, the reform proposal is made publicly available to all relevant stakeholders, including cantons, political parties and other interested groups, as part of a formal consultation process. A new law is then drafted on the basis of the comments received from stakeholders and submitted as a proposal to the parliament. After discussion by the concerned parliamentary committees at the national level, both chambers of parliament have to pass the same version of the law. Finally, depending on the proposed law, the people will be asked to vote on the law or they have the possibility to demand a referendum.

“Making health reforms is particularly complicated in Switzerland as a large consensus is required among the main stakeholders (see Chapter 6). The different steps of the legislative process aim to allow stakeholders to make their opinion known in the early phases of the process in order to avoid a law being rejected by popular referendum at the very end of the legislative process.”

“Various instruments of direct democracy exist, which allow the people to veto new laws or to demand change. First, petitions allow the population to demand changes to the constitution. This requires the signatures of 100,000 voters to be collected within a period of 18 months. Petitions may either be presented in the form of a general proposal or contain the exact amended text of the constitution. Cantons and Members of Parliament have a similar, although less binding, right to make proposals (a so-called state petition).

“Second, a referendum is compulsory for any amendments to the Federal Constitution (i.e. a ballot of the whole population). For an amendment to pass, it must have the support of the majority of valid votes cast (known as a popular majority) and of the majority in more than half of the total number of cantons (known as the majority of states). Third, a referendum must be held for decisions about accession to certain international organizations. Finally, referenda may be held (optional referenda) on all laws and federal decrees passed by Parliament if requested by 50 000 citizens who give their signatures within 90 days. Eight cantons acting together may also seek a referendum.”

“The Federal government’s Health2020 strategy paper, which highlights health priorities for the coming 8 years (2013–2020) (FDHA, 2013), has ‘reinforce international integration’ as one of its 12 objectives. As part of this, Switzerland aims to conclude an agreement with the European Union (EU) which will bring together many existing relations and agreements particularly focusing on health protection. In addition, Switzerland aims to implement its foreign health policy in order to contribute to improving global health (FDFA/FDHA, 2012). On a global scale, Switzerland is an important partner of the WHO (and vice versa), which has its headquarters in Geneva, along with many other international health organizations.”

Switzerland: Political System - Healthcare - National Policies - World Health Systems Facts

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

Page last updated April 23, 2025 by Doug McVay, Editor.