Cassa unica

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 continuing 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 ultimately failed to secure enough signatures. In 2020, the Canton of Neuchâtel launched an identical proposal in the form of a cantonal initiative. However, Parliament again rejected the idea of revisiting a single cantonal health insurance scheme. The debate about a single health insurance scheme has flared up again in recent months. In August 2023, delegates to the SP party conference discussed the launch of a new initiative for a state-run single health insurance scheme. This initiative puts forward the idea that each canton should run its own public 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. Moreover, it can be assumed that administration costs would rise in the case of a monopolist general health insurer without competition. And, lastly, the idea behind a single health insurance scheme is to massively reduce its reserves, which would in turn jeopardize 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.