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“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.”
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.
“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.”
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 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.”
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.
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 in the US and sixteen other nations.
Page last updated March 22, 2021 by Doug McVay, Editor.
