Switzerland: The Healthcare Law Review - Edition 1

Last Updated: 16 October 2017
Article by Markus Wang and Jonas Bornhauser

Most Read Contributor in Switzerland, October 2017

I OVERVIEW

The Swiss healthcare ecosystem is rather complex, since it combines aspects of managed competition and corporatism in a decentralised regulatory framework. The system is characterised by the allocation of decision-making or decision influencing powers to (1) the three different levels of government (the Swiss Confederation, the 26 Swiss cantons and the 2352 municipalities in Switzerland); (2) the recognised private healthcare organisations, such as Swiss Red Cross, Swiss Patient Organisation, Swiss Cancer League and the organisation of the mandatory health insurance (MHI) providers; and (3) the Swiss citizens who can veto against or demand a reform through public referenda and plebiscite.2

The Swiss Confederation (i.e., the federal state) is only permitted to act in those fields in respect of which it is granted powers to do so by the Swiss Constitution. The most important fields are (1) the funding of the health system (through the MHI and other social insurances); (2) ensuring quality and safety of medicinal products and medical devices; (3) ensuring public health (control of infectious diseases, food safety, health promotion); and (4) research and training (third-level education) of non-physician health professionals.3 The most important piece of legislation by which the Swiss Confederation steers the Swiss healthcare system is the Federal Health Insurance Act (HIA),4 which sets the legal framework of the MHI system and in particular defines which services are to be paid by such system.

The Swiss federal government, the so-called Federal Council, and the Swiss parliament enact laws and ordinances that are to be implemented by the Swiss cantons. On a governmental level, the Federal Office of Public Health (FOPH), which is part of the Federal Department of Home Affairs (FDHA), is responsible for the development of national health policies. The responsibilities of the FOPH include other tasks, such as the supervision of mandatory health insurance, decisions on the reimbursement and the prices of therapeutic products and the regulation of university-educated medical and healthcare professions. It also represents the health policy interests of Switzerland in international bodies and with regard to other states.5

The responsibility for the provision of healthcare services lies mainly with the 26 Swiss cantons. The cantons maintain and, together with the MHI, finance hospitals and nursing homes, which they also supervise. In addition, they are also competent to issue and implement certain health-related legislation. The cantons further finance a substantial part of inpatient care, provide subsidies to low-income households enabling such households to pay for insurance, and coordinate prevention and health promotion activities. The Swiss cantons work together on an institutional level through the Swiss Conference of the Cantonal Ministers of Public Health.

The competences and responsibilities of municipalities in the fields of healthcare and other social support services vary across Switzerland, depending on the related allocation of powers and tasks in the cantonal constitutions.

II THE HEALTHCARE ECONOMY

i General

Free healthcare services are available to all persons resident in Switzerland on the basis of the MHI system, irrespective of whether such residents are Swiss citizens or not, are employed or not, or work in the public or private sector. The MHI system, the basic social insurance covering the risk of illness, maternity and (if not covered by another insurance) accidents6 is regulated by the HIA, which entered into force in 1996. The basic principle set forth in the HIA provides that all persons resident in Switzerland have guaranteed access to good medical care. The basic MHI aims to ensure that the costs of required medical treatments are covered by the insurance.7

Every person employed in Switzerland is further covered by the mandatory accident insurance scheme for the health and economic consequences of work-related and non-work-related accidents, as well as occupational diseases (i.e., diseases that are caused in the course of occupational activity solely or principally by harmful substances or certain types of work according to a list issued by the federal government).8 Not covered by mandatory accident insurance are non-employed persons, such as children, students and pensioners. For these persons, coverage for accident is available as part of MHI.

Temporary non-resident visitors have to pay up front for care and must reclaim reimbursement under insurance coverage they may have in their home country.

ii The role of health insurance

Residents are legally required to insure themselves with an MHI provider. Persons moving to Switzerland have to do so within three months as from their arrival.9 Insurance is offered by about 60 competing non-profit MHI companies that are supervised by FOPH. Contrary to private insurers providing complimentary health insurance coverage, the MHI providers must accept all applicants,10 irrespective of age and irrespective of whether they are already ill or not.

The largest share of the health costs is funded by the MHI system. In 2015, the share covered by the MHI system amounted to 35.3 per cent of the total health costs.11 Costs are further covered by direct financing of healthcare providers through the tax-financed budgets of the Swiss Confederation, the cantons and municipalities. The largest portion of such direct financing is made in the form of cantonal subsidies to hospitals providing inpatient acute care. In 2015, the share paid by the cantons amounted to 18.2 per cent of the total health expenditure.12 A further share of the costs is covered by the contributions to other social insurances also providing coverage for health-related risks, such as accident insurance, old-age insurance, disability insurance and military insurance.13

iii Funding and payment for specific services

The healthcare services and products (medicinal products, medical devices and ancillary materials) payable by the MHI are defined by the FDHA. In doing so, it has to evaluate whether the services and products are (1) effective, (2) appropriate, and (3) cost-effective.14

The MHI system pays the costs of most general practitioners (GPs) and specialists, hospital care, home care services (Spitex), physiotherapy (if prescribed), and certain preventive services, including selected vaccinations, general health examinations and screenings for early detection of diseases for certain risk groups. Also covered are the cost of a comprehensive range of medicinal products and medical devices. Care for mental illness is paid by the MHI, if provided by certified physicians. The services of non-physician professionals, such as psychotherapy by psychologists, are only covered if prescribed by a qualified medical doctor and provided in its practice. Long-term care is only paid to the extent necessary medicinal services are concerned. Glasses, to the extent medically required, are partly paid. Procedures and methods used in complementary medicine (such as homeopathy) are covered by the MHI to some extent. Broadly excluded from the MHI is dental care.

Premiums vary for three different age categories and for different geographical regions, but are otherwise the same for every Swiss resident insured with a particular MHI company, independent of gender or health status. In addition, the premiums are not dependent on income. In principle, the insured persons have to pay the premiums themselves. There are no employer contributions. However, people with low income may request a premium reduction, which is subsidised by the Swiss Confederation and the canton of domicile.15 In 2016, cantonal average annual MHI premiums for adults with a minimum franchise of 300 Swiss francs per year and the standard insurance model with accident coverage ranged from 3,920 francs to 6,547 francs.16 The insurers offer specific insurance models, such as health maintenance organisation (HMO) models, which the insured persons may select to benefit from reduced premiums. Insured persons may also reduce the premiums by accepting a higher franchise than 300 francs (presently franchises of up to 2,500 francs for adults and up to 600 francs for children are admissible). Chosen insurance models and selected franchises can be changed every year.

The insured persons have to pay 10 per cent of the cost of services received (above the franchise), including GP consultations, on their own, up to an annual cap of 700 francs for adults and 350 francs for children up to age of 18.17 Where generic drugs are available, patients have to pay 20 per cent of the price themselves if they want the original medicinal product. For hospital stays, patients have to pay an amount of 15 francs per inpatient day.18

Supplementary health insurance plans may be concluded on a voluntary basis and cover benefits that are not paid by the MHI, such as greater freedom with respect to the choice of doctor or hospital, payment of certain methods of complementary medicine that are not reimbursed by MHI or single room accommodation in hospitals. Such complementary insurances are offered by private insurers as well as by MHI insurers.19

To read this Review in full, please click here.

Footnotes

1 Markus Wang is a partner and Jonas Bornhauser an associate at Bär & Karrer.

2 De Pietro et al, in: Quentin Wilm et al. (editors), Switzerland: Health system review, Health Systems in Transition, 2015 (cited: De Pietro et al., Switzerland: Health system review), 17(4):1–288, 19; Sturny Isabelle, in: International Profiles of Health Care Systems, The Swiss Health Care System, 2017 (cited: Sturny), 155-162, 155.

3 Articles 95, 117 and 118 of the Swiss Constitution; De Pietro et al., Switzerland: Health system review, 19.

4 De Pietro et al., Switzerland: Health system review, 19.

5 The Swiss healthcare system, Verband der forschenden pharmazeutischen Firmen der Schweiz (interpharma), accessible online at www.interpharma.ch/fakten-statistiken/4561-swiss-healthcare-system (accessed on 19 July 2017) (cited: The Swiss healthcare system).

6 Article 1a HIA.

7 The Swiss healthcare system, Financing healthcare.

8 Articles 1a and 6 of the Federal Act concerning Accident Insurance.

9 Article 3 HIA.

10 Article 4 HIA.

11 According to figures published by Federal Statistic Office, accessible online at www.bfs.admin.ch/bfs/en/home/statistics/health/costs-financing.html (accessed on 19 July 2017).

12 According to figures published by Federal Statistic Office, accessible online at www.bfs.admin.ch/bfs/en/home/statistics/health/costs-financing.html (accessed on 19 July 2017).

13 Sturny, 156.

14 Article 32 HIA.

15 The Swiss healthcare system, Financing healthcare; Sturny, 155.

16 Swiss Federal Office of Public Health (FOPH), Statistik der obligatorischen Krankenversicherung 2014 (FOPH, 2016).

17 Article 64 para. 2 HIA.

18 Sturny, 156.

19 The Swiss healthcare system, Financing healthcare.

Originally published by The Law Reviews.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
 
Some comments from our readers…
“The articles are extremely timely and highly applicable”
“I often find critical information not available elsewhere”
“As in-house counsel, Mondaq’s service is of great value”

Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.

Disclaimer

Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.

Registration

Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.

Cookies

A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.

Links

This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.

Mail-A-Friend

If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.

Emails

From time to time Mondaq may send you emails promoting Mondaq services including new services. You may opt out of receiving such emails by clicking below.

*** If you do not wish to receive any future announcements of services offered by Mondaq you may opt out by clicking here .

Security

This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.