SHARE
COPY LINK
For members

HEALTH INSURANCE

EXPLAINED: Why do Swiss healthcare premiums vary so much per canton?

Switzerland’s health insurance scheme is not only expensive, but its structure is far from simple, especially when it comes to premiums.

EXPLAINED: Why do Swiss healthcare premiums vary so much per canton?
In an emergency, you can be treated in any canton, like here, in Geneva. Photo by Fabrice COFFRINI / AFP

If you come from a country with a public (that is, government-sponsored) healthcare, as much of the European Union is, Switzerland’s system may leave you perplexed.

It is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage — KVG in German and LaMal in French and Italian — and purchase it from one of dozens of private carriers.

READ MORE: How is Swiss healthcare system different from the rest of Europe?

So far it doesn’t sound too complex, but the plot thickens.

The quality or the span of the basic healthcare is not in question — it includes coverage for illness, hospitalisation, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

The problem is the cost, which has risen over the past 20 years at twice the rate of economic growth, resulting in health insurance premiums that are 90 percent higher today than in 2002.

This has become even clearer on Tuesday, when Health Minister Alain Berset announced that premiums will jump by 6.6 percent on average in 2023 — the sharpest hike in two decades.

While premiums will go up throughout Switzerland, residents of some cantons will have to pay more for healthcare than their counterparts in others.

The highest, above-national-average premiums will hit Neuchâtel (+9.5 percent), Appenzell Innerrhoden (9.3 percent), and Ticino (9.2 percent).

Residents of Zurich will see their premiums increase by 7 percent.

In Vaud and Valais, the rates will hover just below the national average, at 6.1 percent, and in Bern by 6.4 percent. Geneva and Basel, on the other hand, will see their premiums rise by a relatively ‘low’ 4.2 and 3.6 percent, respectively.

READ MORE: Which Swiss cantons will see the biggest increase in health insurance premiums?

Why doesn’t Switzerland have national health premiums — the same across all cantons?

The reason is the decentralised system of government, under which cantons wield a lot of power.

READ MORE: EXPLAINED: Why Switzerland’s cantons are so powerful

In terms of healthcare, responsibilities are divided between the federal and cantonal authorities.

The federal government regulates financing of the health system, ensures the quality of care, as well as safety of drugs and medical devices, and promotes research and training.

It also supervises dozens of private carriers to ensure that they comply with the federal KVG / LaMal law, which prohibits discrimination based on age or health status, withholding necessary treatments, and other provisions guaranteeing that every policyholder gets the same quality of care.

The Federal Office of Public Health (FOPH) is also responsible for approving premiums.

Cantons, on the other hand, are responsible for designing health care policies on their territories, licensing medical providers, coordinating hospital services, and setting healthcare premiums.

Why do the rates vary so significantly among cantons?

The reason is that cantons have different health infrastructure and levels of government funding.

Demographics and statistics also play a role: health premiums in cantons with younger and healthier population will be lower than in those with higher incidence of disease, and older, chronically ill people.

But the mere fact of living in a particular canton doesn’t necessarily mean premiums will be the same for everyone: cantons can also be divided into zones with different premiums.

The government “divides larger cantons, within which costs vary widely, into two or three premium regions”, according to FOPH. “It also determines the maximum permissible differences in premiums between regions”. 

For instance, communes in the cantons of Bern, Graubünden, Lucerne, St. Gallen and Zurich are assigned to three different premium regions. The cantons of Basel-Country, Fribourg, Schaffhausen, Ticino, Vaud and Valais each have two premium regions.

Does this mean you can only be treated in your own canton / region of residence?

It all depends on what kind of medical help you are seeking.

For instance, if, for whatever reason you want to consult a doctor or get an elective surgery in another canton, your health insurance will not totally cover the costs.

KVG / LaMal will only pay for treatment (both outpatient and in-hospital) in the canton where the patient lives.

However, this rule applies only to non-urgent situations; emergency cases are treated differently.

If you injure yourself skiing or require urgent surgery while visiting another canton and can’t be easily transferred to a hospital close to your home, then your insurance will cover all the the costs of medical treatment.

“In an emergency, you can go to any hospital in Switzerland”, FOPH said, adding that it must be an authorised public health facility, rather than a private clinic, which in principle is not covered by the basic insurance, but only by supplemental coverage.

READ MORE: Will my Swiss health insurance cover treatment in another canton?

Member comments

Log in here to leave a comment.
Become a Member to leave a comment.
For members

HEALTH INSURANCE

REMINDER: Key tips on changing your Swiss health insurance as deadline nears

If you are unsatisfied with your health insurance plan or want to take out a cheaper one, you need to act fast — the November 30th deadline is fast approaching. Here are a few last-minute tips.

REMINDER: Key tips on changing your Swiss health insurance as deadline nears

What’s happening?

Switzerland’s world-class healthcare system comes with a price, but while most options are costly, choosing the right plan can save you hundreds of francs per month. 

This is all the more relevant now, as the cost of premiums for the compulsory (KVG / LaMal) coverage is set to increase by 6.6 percent on average in 2023 — and in some cantons by even more.

For instance, the highest, above-national-average premiums will hit Neuchâtel (+9.5 percent), Appenzell Innerrhoden (+9.3 percent), and Ticino (+9.2 percent).

Residents of Zurich will see their premiums increase by 7 percent.

READ MORE: Which Swiss cantons will see the biggest increase in health insurance premiums?

Rates are set by the cantons, but while changing your place of residence just to get a cheaper health insurance may not be a viable option, in many cases, you can get the same benefits as you currently get for a lower price just by changing your carriers — not cantons.

However, f you want to switch your provider for 2023, you must do this by November 30th.

This can be the case particularly for foreigners in Switzerland, who may have come to the country and been signed up for an insurance plan – for instance through recommendations from friends or workmates – without properly knowing the ins and outs of the healthcare system. 

The following guide provides info on how to change your healthcare provider, but keep in mind that if you want to cancel your current plan and switch to another one, you must notify your carrier, by registered post, by November 30th at the latest.

However, there is a certain process you must follow if you are changing carriers.

This is what you should do

If you do decide to part ways with your current provider, make sure you have another policy in its place before making the switch. Health insurance is compulsory in Switzerland for every resident, whether Swiss or foreign, so you can’t be without coverage even for a short period of time.

As stated above, the insurance carrier must receive your termination letter, sent by registered mail, no later than November 30th.

You must attach proof that you have taken out a new insurance policy.

Any outstanding monthly premiums must be paid before you can make the switch.

You can use these templates in German, French, or Italian to create the cancellation letter.

READ MORE: How to change your health insurance carrier in Switzerland 

How do you find a cheaper plan?

Hopefully, you have done so already, but if not, you must really hurry to get this done in the few days that you have left.

These are the less expensive alternatives:

Health maintenance organisation (HMO)

Under this model, policyholders are required to consult a particular HMO practice. Two disadvantages of this alternative is a limited choice of doctors and you also need a referral to see a specialist.

However, the benefit is a premium reduction of up to 25 percent compared to the conventional insurance.

Family doctor model

Your family doctor, a general practitioner, will be designated by your insurance company and will be in charge of all your medical treatment.

He or she will refer you to a specialist if necessary. 

If you opt for this option, you could save 20 percent on your insurance.

The Telmed alternative

If you choose this option, you have to call a telephone service and get a referral to a doctor or hospital.

This does not apply to medical emergencies and other exceptions, such as eye exams and annual gynecological check-ups.

Total savings could range between 15 and 20 percent. 

Increase your deductible

In Switzerland, the deductible (franchise) ranges from 300 to 2,500 francs.

The lower your deductible, the higher your premiums, and vice-versa.

If you are young, healthy, hardly ever get ill, and don’t take any expensive medications, then you can save substantially with the highest franchise.

Keep in mind, however, that if you choose the highest deductible and end up needing medical care, you will have to pay a greater proportion of the costs.

Pay the premiums in one lump sum

Most insurance carriers will give you a 2-percent reduction if you pay your premiums upfront rather than on monthly basis.

So if you want to keep your current plan, this may be a good cost-cutting option, provided you can pay the hefty amount in one lump sum.

Keep in mind that November 30th is the deadline not only for switching from one insurance carrier to another, but also for notifying your current company about the changes you want to make to your deductible or any other tweaks to your policy.

READ MORE: Everything you need to know about health insurance in Switzerland

SHOW COMMENTS