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.
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.
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.
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.
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.