Healthcare in Switzerland is universal and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland. Health insurance covers the costs of medical treatment and hospitalisation of the insured. However, the insured person pays part of the cost of treatment. This is done by means of an annual deductible, which ranges from CHF 300 to a maximum of CHF 2,500 for an adult as chosen by the insured person and by a charge of 10% of the costs over and above the excess up to a stop-loss amount of CHF 700.
Compulsory coverage and costs
Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Swiss Federal Law on Health Insurance ; la loi fédérale sur l’assurance-maladie ; legge federale sull’assicurazione malattie ). It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans. The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium. The universal compulsory coverage provides for treatment in case of illness or accident and pregnancy. Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person pays part of the cost of treatment. This is done by these ways:
by means of an annual excess, which ranges from CHF 300 to a maximum of CHF 2,500 for an adult as chosen by the insured person ;
by a charge of 10% of the costs over and above the excess. This is known as the retention, and is up to a maximum of 700CHF per year.
In case of pregnancy, there is no charge. For hospitalisation, one pays a contribution to room and service costs. Insurance premiums vary from insurance company to company, the excess level chosen, the place of residence of the insured person and the degree of supplementary benefit coverage chosen. In 2014, the average monthly compulsory basic health insurance premiums in Switzerland are the following:
International civil servants, members of embassies, and their family members are exempted from compulsory health insurance. Requests for exemptions are handled by the respective cantonal authority and have to be addressed to them directly.
Private coverage
The compulsory insurance can be supplemented by private "complementary" insurance policies that allow for coverage of some of the treatment categories not covered by the basic insurance or to improve the standard of room and service in case of hospitalisation. This can include complementary medicine, routine dental treatments, half-private or private ward hospitalisation, and others, which are not covered by the compulsory insurance. As far as the compulsory health insurance is concerned, the insurance companies cannot set any conditions relating to age, sex or state of health for coverage. Although the level of premium can vary from one company to another, they must be identical within the same company for all insured persons of the same age group and region, regardless of sex or state of health. This does not apply to complementary insurance, where premiums are risk-based.
Organization
The Swiss healthcare system is a combination of public, subsidised private and totally private systems:
subsidised private: the home care services to which one may have recourse in case of a difficult pregnancy, after childbirth, illness, accident, handicap or old age;
totally private: doctors in private practice and in private clinics.
The insured person has full freedom of choice among the recognised healthcare providers competent to treat their condition on the understanding that the costs are covered by the insurance up to the level of the official tariff. There is freedom of choice when selecting an insurance company to which one pays a premium, usually on a monthly basis. The list of officially approved insurance companies can be obtained from the cantonal authority.
Before the discussions about a nation-wide implementation, electronic health records were widely used in both private and public healthcare organizations. In 2007, the Swiss Federal Government approved a national strategy for adoption of e-health. A central element of this strategy is a nationwide electronic health record. Following the federal tradition of Switzerland, it is planned that the infrastructure will be implemented in a decentralized way, i.e. using an access and control mechanism for federating existing records. In order to govern legal and financial aspects of the future nationwide EHR implementation, a bill was passed by the Swiss Federal Government in 2013, but left open questions regarding mandatory application. The Federal Act on the Electronic Patient Recordcame into force on 15 April 2017, but the records will not be universally available until 2020. It will be extended to birth centres and nursing homes in 2022. Both patients and clinicians can store and access health data in the records.
Primary care
The ‘netCare’ scheme for minor ailments was introduced nationally in 2016. Pharmacists conduct a standardised triage and can prescribe medication. They can also have an unscheduled teleconsultation with a physician.
Hospitals
Statistics
Healthcare costs in Switzerland are 11.4% of GDP, comparable to Germany and France and other European countries, but significantly less than in the USA. By 2015 the cost had risen to 11.7% of GDP -the second highest in Europe. Benefits paid out as a percentage of premiums were 90.4% in 2011. Total gross benefits per person and per year in 2011 were CHF 3,171, of which CHF 455 are cost sharing. According to the OECD Switzerland has the highest density of nurses among 27 measured countries, namely 17.4 nurses per thousand people in 2013. The density of practising physicians is 4 per thousand population. In the 2018 Euro health consumer index survey Switzerland was placed first overtaking the Netherlands, and described as an excellent, although expensive, healthcare system.
