JANUARY

The Swiss Health Care System, 2015
Paul Camenzind
Swiss Health Observatory
What is the role of government?
Duties and responsibilities in the Swiss health care system are divided among the federal, cantonal, and
communal levels of government. The system can be considered highly decentralized, as the cantons are given
a critical role. The 26 cantons (including six half-cantons) are responsible for licensing providers, coordinating
hospital services, and subsidizing institutions and organizations. Cantons are like U.S. states in that they are
sovereign in all matters, including health care, that are not specifically designated as the responsibility of the
Swiss Confederation by the federal constitution. Each canton and half-canton has its own constitution
articulating a comprehensive body of legislation.
Who is covered and how is insurance financed?
Publicly financed health insurance: There are three streams of public funding:
1. Direct financing for health care providers through tax-financed budgets for the Swiss Confederation, cantons,
and municipalities. The largest portion of this spending is given as cantonal subsidies to hospitals providing
inpatient acute care.
2. Mandatory statutory health insurance (SHI) premiums.
3. Social insurance contributions from health-related coverage of accident insurance, old-age insurance, disability
insurance, and military insurance.
All government expenditures are financed by general taxation. In 2013, direct spending by government
accounted for 20.2 percent of total health expenditures (CHF69.2 billion, or USD50.5 billion), while income-based
SHI subsidies accounted for an additional 5.8 percent. 1 Including SHI premiums (30.9% of total health
expenditure, excluding statutory subsidies), other social insurance schemes (6.5%), and old age and disability
benefits (4.4%), publicly financed health care accounted for 67.9 percent of all spending (SFOS, 2015a).
Mandatory SHI coverage is universal. Residents are legally required to purchase SHI within three months of arrival
in Switzerland, which then applies retroactively to the arrival date. Policies typically apply to the individual, are
not sponsored by employers, and must be purchased separately for dependents.
There are virtually no uninsured residents. Temporary nonresident visitors pay for care up front, and must claim
expenses from any coverage they may hold in their home country. Missing SHI for undocumented immigrants
remains an unsolved problem acknowledged by the Swiss Federal Council (SFC), the highest governing and
executive authority.
SHI is offered by competing nonprofit insurers supervised by the Federal Office of Public Health (FOPH), which
sets floors for premiums offered to cover past, current, and estimated future costs for insured individuals in
a given region. Cantonal average annual premiums in 2015 for adults range from CHF3,836 (USD2,800) to
CHF6,398 (USD4,670) (Appenzell Innerrhoden; Basel-Stadt). Funds are redistributed among insurers by a central
fund, in accordance with a risk equalization scheme adjusted for canton, age, gender, and hospital or nursing
home stays of more than three days in the previous year.
1
Please note that, throughout this profile, all figures in USD were converted from CHF at a rate of about CHF1.37 per USD,
the purchasing power parity conversion rate for GDP in 2014 reported by OECD (2015) for Switzerland.
International Profiles of Health Care Systems, 2015 161