The Swiss healthcare system is widely regarded as one of the best in the world and for good reason. It was developed based on a mandatory health insurance model that ensures all citizens and residents have access to essential healthcare services, regardless of their financial background or socioeconomic status. The system is designed to be comprehensive, efficient, and patient-centered, focusing on providing high-quality care to all.
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The Mandatory Health Insurance Model
Under the mandatory Swiss health insurance model, everyone living in Switzerland is required to have basic health insurance coverage. Each person can choose their insurance provider and deductible (called “franchise” in German). Specific rates are based on things like age, health status, and location.
The insurance market is regulated by the government to ensure comprehensive and affordable health insurance for all. And one big advantage of the Swiss health system is that costs are spread across all individuals giving access to world-class hospitals and health care for all.
Who is Eligible For Coverage
Because healthcare coverage is mandatory for everyone, there are no exceptions for eligibility. So, health care coverage includes all residents of Switzerland, including:
- Swiss nationals
- Expats
- Temporary residents (eg. students, asylum seekers)
- People with pre-existing conditions
Costs and Funding
The Swiss healthcare system actually spends the most of any country per capita, except for the USA. So, it is a world-class healthcare system, but it is expensive. So, who pays for it?
There are four different ways the Swiss healthcare system is funded:
- Compulsory health insurance premiums: The premiums paid by all Swiss residents for basic health insurance. This money goes to private companies.
- Deductibles: In addition to insurance premiums, there is a certain amount of money that has to be spent on health care services before the insurer pays anything. In German this is called the “franchise” but in English, it is often referred to as the deductible or excess. On top of this, only 90% of the costs are paid by the insurer, even once this threshold is exceeded.
- Employer contributions: All Employers in Switzerland pay for their employees accident insurance. This is separate from basic health insurance in that it only covers workplace and non-workplace accidents.
- Government subsidies: The Swiss government also provides financial support to the healthcare system through subsidies for low-income individuals
- Taxes: The government also uses tax money to support a range of medical services including hospitals, emergency services and the insurers to make sure that costs are covered and prices do not skyrocket.
The Differences Between Private and Public Care
There are two levels of health insurance in Switzerland, but it is a little more complex than first meets the eye.
- Basic insurance: The basic coverage for health insurance is the one that all people pay in Switzerland. It is mandatory and gives people access to all the medical treatment they fundamentally need. It is the minimum level of coverage.
- Private health insurance: If Swiss residents and citizens wish to have a higher level of coverage they can pay for various supplemental insurances. There are some simple private insurances that cover things like vaccinations for travel and medicinal massages. There is other more expensive private insurance that gives coverage for full private hospital cover. And there are some that are in-between where you can choose to go semi-private or private and then pay some extra when and if you have to go to the hospital.
What does the Basic Healthcare Cover?
The basic, mandatory health insurance in Switzerland covers a huge range of medical treatment and services:
- Medical consultations and treatment: Typical consultations with doctors, specialists, and other healthcare professionals, including diagnostic tests and treatments.
- Hospitalization: Treatment in a public hospital or a recognized private hospital, in a shared room within the canton of residence. In case of medical necessity, hospitalization outside the canton of residence may also be covered.
- Maternity care: Prenatal and postnatal care, including check-ups, tests, childbirth, and necessary medical care during pregnancy and after delivery.
- Prescription medications: Prescription drugs that are approved and listed in the Swiss Medicines Compendium, as long as they are prescribed by a healthcare professional.
- Medical aids and devices: Necessary medical aids and devices, such as wheelchairs, hearing aids, and orthopedic shoes.
- Rehabilitation: Necessary rehabilitation services following an illness or injury, including physical therapy, occupational therapy, and speech therapy.
- Preventive measures: Certain preventive care services, such as vaccinations, screenings, and check-ups, as recommended by the Federal Office of Public Health (FOPH).
- Home care and nursing care: Home healthcare and nursing services, when prescribed by a healthcare professional and carried out by qualified personnel.
- Mental health care: Psychiatric and psychotherapeutic treatment provided by qualified healthcare professionals, in accordance with the regulations and limitations set by the basic insurance.
- Palliative care: Necessary palliative care services for patients with a life-limiting illness, aiming to improve their quality of life and provide support to their families.
