CSS's position on health policy issues

Single (cantonal) health insurance scheme

The Swiss electorate has rejected the idea of a single public health insurer on several occasions. The most recent initiative to introduce a single health insurance scheme nationwide was held on 28 September 2014, and it was clearly rejected with 61.8% "No" votes, indicating the population's clear endorsement of the competition-based healthcare system whose funding is based on social solidarity. A popular initiative was launched in western Switzerland in autumn 2017 to create a single health insurance scheme for each canton. The initiative failed to secure enough signatures. Subsequently, the Cantons of Neuchâtel (2020), Vaud (2021) and Geneva (2023) launched similar proposals in the form of cantonal initiatives. However, Parliament again rejected the various attempts to put a single cantonal health insurance scheme back on the agenda.

Nevertheless, in view of rising healthcare spending, the debate about a single health insurance scheme remains topical. The SP (Swiss Social Democratic Party) announced its intention to launch an initiative for a public, social health insurance scheme in August 2023. The launch date and exact contents of the initiative – including whether it is calling for national, cantonal or regional schemes – remain unclear.

CSS rejects the idea of a single health insurance scheme for all of Switzerland – as well as at the regional and cantonal level – as this will not solve the problem with costs. On the one hand, cantonal premiums reflect the trend in costs at the cantonal level. Curbing the rise in premiums essentially means taking measures to contain costs. On the other hand, healthcare costs are not rising because of health insurers and their administration costs, which only account for 5% of the total. The main cost drivers are benefit costs, which make up around 95% of total expenditure, and on which a single health insurance scheme would have no impact whatsoever. Competition between health insurers currently leads to high quality and efficient invoice checking, which works in favour of the premium payers by preventing benefits from being paid unnecessarily. In addition, insured persons have a wide range of innovative products and services to choose from and enjoy premium discounts when opting for an alternative insurance model. Under a system monopolised by a single general health insurer, insured persons would lose this freedom of choice and thus the possibility afforded them by law of changing health insurers. Examples from abroad show that single state health insurance schemes can lead to poorer healthcare, debt and a two-tier system.

Integrated care

Promoting integrated care has been a key concern of CSS for many years. An integrated care approach aims to ensure that the stakeholders involved work more closely together and provide patients with a continuum of care. This coordination between providers and levels, along with active client involvement, should lead to optimised quality of treatment and savings on benefit costs. The standardised financing of outpatient and inpatient benefits (EFAS), which was approved by the Swiss electorate on 24 November 2024 and will come into force for acute services on 1 January 2028, gives integrated care renewed impetus (see our standpoint on the "Implementation of uniform financing").

The delivery of effective integrated care in regional networks calls particularly for more flexibility in the existing structures and models of collaboration. But tariff and financing models must also be designed to apply across sectors and be value-based – for example, using flat rates, coordination payments and initial funding. At the same time, new roles must be created, and this must be accompanied by a change in culture that will enable these new roles to become established. A suitable digital infrastructure and quality-driven data usage would provide an additional boost, making it easier for cooperation and improved coordination between the different stakeholders to succeed.

To achieve this, CSS intends, for example, to continue building its partnerships with integrated healthcare networks, such as those in Morges (Ensemble Hospitalier de la Côte (EHC)), Jura, Biel-Bienne and Ticino. Digital networking has emerged as a key factor in making integrated care a success: If data is exchanged between stakeholders and made accessible to them, an optimised treatment pathway can be followed. It is envisioned that the use of electronic health records by all actors in the network will ensure that service providers share information and thus avoid duplication. To make sure that clients also have access to their health data at all times and that they can share it with others if need be, the WELL online platform has been made an integral part of the EHC healthcare network in Morges.

You can find further information on the topic of integrated care in our publication on health policies "im dialog" 2/2020 (in german).

Implementation of uniform financing (shift towards outpatient settings and nursing care)

The uniform financing of healthcare benefits, which was approved by the electorate in November 2024, means that, in future, health insurers will pay 100% of the costs in all service areas while the cantons will fund a share of the total costs in their canton (currently at least 26.9% of the total costs). These funds will find their way back into the system, thus benefiting the premium payers. The reform has huge potential to encourage a shift towards outpatient settings and provide fresh impetus for integrated care, and thus have a positive effect on healthcare costs and premiums. The amendment of the law comes into force for acute services on 1 January 2028 and for nursing and care services on 1 January 2032.

The next few years will decide whether the full potential of uniform financing can be unlocked. All the actors in the healthcare system are now called upon to play their part in ensuring that implementation succeeds. The following areas take priority:

Promoting outpatient services

Outpatient treatment is generally cheaper than inpatient treatment and often makes more sense medically. However, at present the costs are completely covered by the premiums. As a result, the bill for shifting from inpatient to outpatient care, as championed by the policymakers, is borne solely by the premium payers. Uniform financing eliminates this false incentive and paves the way for accelerating the shift towards outpatient settings. However, further measures need to be taken, both at the tariff and structural level, if noticeable progress is to be achieved. CSS is working together with service providers, cantons and other health insurance companies to come up with solutions capable of delivering results. In addition to having a positive effect on costs, greater outpatient delivery will also bring qualitative benefits for patients, as outpatient procedures tend to be less stressful.

Strengthening integrated care

Duplication and unnecessary treatment can be avoided through properly coordinated care, especially for the chronically ill, which then has a positive effect on quality and costs. However, until now, the different financing arrangements have restricted the potential of integrated care: Coordination costs are primarily incurred in an outpatient setting, which is funded through premiums, while savings are mostly made in inpatient care (e.g. by avoiding hospitalisation). Uniform financing will enable such savings to be passed on to the insured persons more directly in future (e.g. in the form of higher discounts on alternative insurance models), thus making coordinated care more attractive to everyone.

Complementary roles of insurers and cantonal authorities in checking invoices

The legislators have decided to grant the cantonal authorities a right to object to the payment of bills for inpatient treatment. As work gets underway on implementing the reform, it will be important to ensure that the cantonal checks are kept as lean and unbureaucratic as possible. In addition, the data and financial flows between the insurers and the cantons must be designed in such a way that process efficiency is ensured.

Cost transparency in relation to long-term care

Consistent cost transparency in relation to long-term care is a fundamental requirement if the planned system of uniform financing is to be implemented properly. If cost structures are not clearly disclosed and comparable, new tariffs for nursing care risk being inefficient, imbalanced or non-verifiable. Therefore, the tariff partners should establish binding standards for collecting, analysing and publishing data; this would ensure a transparent basis for developing a new tariff structure (by 2032).

Family caregivers

Family caregivers are individuals who provide care to relatives. The support they provide is generally of huge value to society and the healthcare system.

A Federal Supreme Court decision of 2019 paved the way for family caregivers to be remunerated under mandatory healthcare insurance (OKP) for providing certain care services – even if they have no formal training. This decision gave rise to a new model: Family caregivers may now be employed by a Spitex organisation and charge for their care services. Some private Spitex organisations have begun specialising exclusively in hiring family caregivers.

Not only has the number of private Spitex organisations risen since the decision, the number of people providing care to someone in the family has gone up too, with the costs charged to mandatory healthcare insurance therefore increasing exponentially. Unclear and missing legal definitions and imprecise distinctions currently mean that services are being billed under basic insurance which should really be classed as private care. In addition, patient safety and quality of care are not always guaranteed.

CSS is an advocate for clear and uniform framework conditions designed to guarantee quality assurance and to ensure that only care services which satisfy the principles of mandatory healthcare insurance are actually refunded. CSS sees a particular need for action in relation to the scope of services/benefits, the training requirements and the criteria for recognising Spitex organisations.

Lowering the OKP contribution rate for family caregivers should also be considered. Moreover, the services provided by family caregivers must be clearly identified as such to make the process of checking bills both efficient and effective. These measures could be implemented primarily by means of amendments to the Health Insurance Ordinance and the Health Insurance Benefits Ordinance (KVV and KLV), and by the Swiss Conference of the Cantonal Ministers of Public Health (GDK) drawing up standardised criteria for the recognition of Spitex organisations.

Tariff structures

CSS champions the active further development of the tariff structures. It espouses the primacy of the criterion of "appropriateness" and supports a strict separation of structure and price. The tariff structures must reflect current medical knowledge, enable services to be provided cost effectively and take changing healthcare structures into consideration. Ensuring that any new tariffs introduced satisfy the cost neutrality criteria required by law is also of crucial importance. CSS considers tariff autonomy and a functioning tariff partnership to be an important element of competition and supports every effort to find a solution to the negotiations. But it also supports subsidiary interventions by the Federal Council if tariff autonomy fails to lead to a solution that is both fit for purpose and acceptable to the premium payers.

After many years of discussion, the new outpatient tariff (TARDOC and the first flat rates) replaced the outdated TARMED as of 1 January 2026. CSS actively campaigned for the replacement of TARMED for a number of years. Monitoring measures designed to ensure the cost neutrality required by law and corrective measures to be taken if the increase in costs turns out higher than expected will play a key role in the introduction of the new tariff. CSS welcomes the fact that the outpatient tariff is to be reviewed each year from now on, as this should guarantee that the tariff remains fit for purpose.

Digitalisation and the use of data

Digitalisation and the use of data play a fundamental role in shaping the healthcare system of the future. Although there is basic agreement that the healthcare system must be digitalised, the transformation is making only slow progress. The revision concerning electronic patient records (EPR) kept everyone waiting. In November 2025, the Federal Council finally resolved on a fundamental shift: the EPR is to be replaced by the electronic health record (E-HR). To this effect, the Federal Council approved the dispatch on the new federal act on the electronic health record (EGDG) and submitted it to Parliament. In CSS's view, the E-HR must be designed in such a way that it best supports both service providers and insured persons along the entire treatment pathway, thus making it a valuable focal point for care delivery and prevention. Without a meaningful E-HR, the digital transformation of the healthcare system will continue to stagnate and Switzerland will fall even further behind other countries.

To fill the existing gap and accelerate the pace of digitalisation in the Swiss healthcare system, CSS champions its own innovative solutions for future-proof healthcare. For example, together with its partners, CSS has launched the digital health platform Well, which offers interactive access to healthcare to everyone living in Switzerland and is open to all stakeholders (service providers, insurance companies, pharmacies, etc.). With the aid of mobile devices, chronically ill patients can monitor their condition and get in touch with healthcare professionals at any time thanks to Well. Moreover, Well guarantees digitally supported integrated care within the EHC care network, with which CSS cooperates. Such platforms demonstrate which solutions work in the market and actually deliver added value to insured persons and service providers. The E-HR must learn from these experiences.

Digitalisation not only increases transparency for insured persons. Thanks to data analyses conducted by the institutions, it also boosts transparency regarding the services they provide. This, in turn, can improve quality and rein in costs. Digitalisation also enables better coverage of client needs. Thus, for example, CSS offers its clients personalised medical advice, among other things, through Well, which is available 24/7. Insured persons can also take responsibility for their personal health within programmes such as active365. The programme conveys knowledge on various aspects of leading a healthy lifestyle and rewards activities in relation to nutrition, exercise, mindfulness and mental health.

Making healthcare delivery better and more efficient does not require more data, it requires smarter use to be made of the data that already exists. Standardised and binding data structures and content are essential to ensuring that systems are interoperable and can work together seamlessly. Digitalisation can only make headway if there is a good and efficient data system: In future, it must be possible to store and process data in a structured manner in order to ensure data reusability. That calls for clear legal framework conditions, secure environments and genuine data sovereignty for everyone involved. Only then can the security of data be guaranteed without hampering the potential of digitalisation.

The DigiSanté programme launched by the Federal Council addresses a large part of these political demands, with the aim of making the Swiss healthcare system digitally fit for the future by 2034. The programme began in earnest in the first half of 2025. CSS supports these efforts to finally lay the groundwork for data-driven healthcare. At the same time, CSS expects the E-HR, as a core element of the Swiss Health Data Space being developed under the DigiSanté project, to be built in by design. Only then can the E-HR become a valuable connecting point between care delivery, prevention and research.

Brokers' commissions

When it comes to acquiring new clients, CSS relies heavily on its own sales force. But it also works with brokers. In order to promote high quality and cost-effective advice, CSS is in favour of stepping up cooperation throughout the entire health insurance industry by means of a self-regulatory industry agreement for basic and supplementary insurance.

An industry agreement regulating unwanted sales calls and brokers' commissions, which have given rise to discussions for years, has been in place since 1 January 2021. CSS has applied this industry agreement from the very beginning. CSS joined forces with the former national industry associations curafutura and santésuisse in an effort to get the Federal Council to declare the agreement generally binding and so create a level playing field for all insurers. On 14 August 2024, the Federal Council declared the industry agreement on brokers 3.0 generally binding, effective 1 September 2024. Insurers may pay intermediaries a maximum of CHF 70 as commission for successfully selling basic insurance, and an amount equal to no more than 16 net monthly premiums for supplementary insurance. It is crucial that all insurers stick to the new rules. CSS expects the authorities (the FOPH for KVG, and FINMA for VVG) to monitor compliance with the rules.