What is the role of government?
Duties and responsibilities in the Swiss health system are divided between three governmental levels: federal,
cantonal, and communal. The system can be considered highly decentralized, as the cantons are given a critical
role. The 26 cantons (including six demicantons) are responsible for licensing providers, hospital planning, and
the subsidizing of institutions and organizations. Cantons are like states, in that they are sovereign in all matters
that are not specifically designated as the responsibility of the Swiss Confederation by the federal constitution.
Each canton and demicanton has its own constitution articulating a comprehensive body of legislation.
Who is covered?
Coverage is universal, with residents mandated under the 1996 Federal Health Insurance Act (FHIA) to purchase
statutory health insurance (SHI) from competing insurers. There are virtually no uninsured residents.
Every individual intending to reside in Switzerland is required, within three months of arrival, to take out an
insurance policy, which is then applied retroactively to the arrival date. The federal council acknowledges the
unsolved problem of missing SHI for undocumented immigrants and supports better insurance coverage for
these “sans papiers.”
SHI typically applies to the individual. It is not sponsored by employers, and individuals must purchase separate
policies for dependents. Many residents also purchase complementary and supplementary voluntary health
insurance (VHI) for coverage of services not covered under the basic basket, for free choice of hospital doctor,
or for improved accommodation (e.g., an individual or twin room instead of a shared room) when hospitalized.
What is covered?
Services: The Federal Department of Home Affairs (FDHA, i.e., the Ministry of Health) decides whether or not to
include a service in the SHI benefits basket by evaluating whether the service is effective, appropriate, and costeffective.
It is supported in this task by the Federal Office of Public Health (FOPH) and by Swissmedic, the
Swiss agency for the authorization and supervision of therapeutic products.
SHI covers most general practitioner (GP) and specialist services, as well as an extensive list of pharmaceuticals,
medical devices, home health care (called Spitex), physiotherapy (if prescribed by a physician), and some
preventive measures, including the costs of selected vaccinations, selected general health examinations, and
screenings for early detection of disease among certain risk groups and for certain diseases (e.g., one mammogram
a year if a woman has a family history of breast cancer).
Hospital services are covered by SHI, but highly subsidized by the cantons (further described below). Care for
mental illnesses is covered if provided by certified physicians. The services of nonmedical professionals (e.g.,
psychotherapy by psychologists) are covered only if prescribed by a qualified medical doctor and provided to
patients in the doctors’ practice. SHI covers only “medically necessary” services in long-term care. Dental care is