Single 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. In August 2023, delegates to the SP party conference discussed the launch of a new initiative for a state-run single health insurance scheme, for which signatures are to be collected in 2025. This initiative demands that each canton run its own public general health insurance programme, with the possibility of inter-cantonal schemes. Premiums would be linked to economic capacity and capped at 10% of income.

CSS rejects the idea of a single health insurance scheme for all of Switzerland – as well as at the regional and cantonal level. 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.

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. Moreover, it can be assumed that administration costs would rise in the case of a monopolist general health insurer without competition. Lastly, the idea behind a single health insurance scheme is to massively reduce the reserves, which would in turn jeopardise the institution’s financial stability given even the slightest misjudgement of how costs were likely to develop. The resulting financial imbalance could then only be corrected through a substantial increase in premiums or using taxpayers’ money.