The Swiss Federal Health Insurance Act

Daliah Kremer/Alice Fiorentzis

The Federal Health Insurance Act (KVG) has been causing tension for more than 20 years. What are the positive aspects of it? What problems exist?

Virtually no other topic makes more headlines: 200 different media reported on the healthcare system as many as 23,000 times in 2015. Health-related issues are also regularly voted on at the ballot box. 13 initiatives have been voted on since the introduction of the KVG. This accounts for 20 per cent of all initiative votes. Neither taxes, immigration policy, old age and survivors’ insurance (OASI) nor energy-related issues make Swiss people’s blood boil more intensely.

Inefficiencies are a burden on the system

Two objectives have been reached since the KVG came into force: the successful introduction of the solidarity system and a high level of healthcare. On the other hand, efforts to curb costs have failed. The annual expenditure on basic insurance has increased from an initial figure of 13.4 billion francs to the current amount of more than 31 billion. It is not easy to answer the question as to why our healthcare system costs so much. Medical advances, prosperity, our aging society and federalism – all of the above push costs up.

Lots of room for improvement in the system

As far as prosperity is concerned, it has been observed in various countries that economic growth goes hand in hand with rising healthcare costs. Ever-increasing life expectancy is also driving up costs: multimorbidity – which means the simultaneous presence of several illnesses in an individual – and chronic illnesses are on the increase. And this all costs money. However, there is no scientific consensus on how strongly each of these factors affects the respective costs in real terms. Federalism also contributes to inefficiency: 26 cantons with 26 different healthcare systems. It is understandable that every canton is also intent on retaining its autonomy in relation to the healthcare system, but there is a price to pay for maintaining this system.

Gradual reforms

However, there are still no sensible solutions for these problem areas. The KVG objective that has not been met will remain an issue for the Swiss healthcare system over the next 20 years. It is clear that the KVG will not be able to solve this problem. It is a financing law and not a healthcare law. Only dialogue can bring about a solution. The key to reforms in Switzerland is successful projects at cantonal level. They can make an impact beyond cantonal borders and catch on all over Switzerland.

The KVG – a Swiss success story?

The book “Das KVG – eine Schweizer Erfolgsstory?” (The KVG – a Swiss Success Story) analyses the impact of 20 years of the Federal Health Insurance Act in Switzerland. 20 experts take stock and carry out a critical assessment of it. Thomas D. Szucs edited the book. He is Professor and Director of the Institute for Pharmaceutical Medicine at the University of Basel, Switzerland and has been the Chairman of the Board of Directors of the Helsana Group since 2010.

Published by the Orell Füssli Verlag, ISBN 978-3-280-05620-2

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Topics containing this article

Health policy

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