European Universal Healthcare

What applies today

The Health Insurance Act (KVG) was passed by parliament on 18 March 1994. A referendum was called against it. In the popular vote of 4 December 1994 it was accepted with 1,021,175 yes against 950,360 no, that is 51.8 per cent. It has been in force since 1 January 1996.

The KVG introduced compulsory cover: basic insurance for everyone resident in Switzerland, with a binding catalogue of benefits and gender-neutral premiums. The premium is a flat per-head charge. It is not graded by income. Anyone earning too little applies for a premium subsidy.

What applied before

Before that the Sickness and Accident Insurance Act (KUVG) applied. Its constitutional basis, article 34bis, was created in 1890. The act was accepted in the popular vote of 4 February 1912 and remained in force until 1995.

Under the KUVG accident insurance was compulsory but health insurance was not. It was voluntary, largely tied to the employer, and ran through federally subsidised sickness funds. Some cantons and cities already had an obligation for low-income households in the early 20th century. There was no nationwide obligation for 84 years.

The trail runs back to the 13th century. Zurich's first hospital was run by a lay brotherhood until 1300, then by a civic hospital master. It financed itself from endowments and donations, because the inmates could not pay for their stay.

Hospitals then were not places of healing but welfare institutions for the needy of every kind. They were carried first by ecclesiastical institutions, later by towns and communes. They became hospitals in today's sense only in the 19th century.

Nursing the sick was first of all the family's task, and above all the women's. Only when that network was missing did people seek refuge in the hospital. There was no doctor resident in the hospital; for treatment the barber-surgeon was called. Academic physicians gained weight in Basel only with the founding of the university in 1460.

Who was insured

The statistics run back to 1914, when the Confederation began subsidising the funds. For the years 1914 to 1960, membership is recorded by sex and as a share of the population. In the early years the insured were mostly male workers.

By 1960, 80 per cent of the resident population already belonged to a fund. More than a thousand funds were operating into the 1960s; in 1950 there were 1,154 of them.

Before 1996, 97 per cent of the population was insured voluntarily. The obligation did not create coverage; it added about three points to it.

What it did change was different. Funds could previously reject bad risks, and premiums graded by age of entry tied the insured to their fund. The KVG brought an obligation to accept everyone, a uniform catalogue of benefits, free choice of fund and risk equalisation.

What it costs

In 1996, the first year of compulsory cover, the average premium was 128 francs a month. In 2026 it is 393.30 francs. For adults aged 26 and over it is 465.30 francs, for young adults 326.30 and for children 122.50.

The chart converts the average premium published by the FOPH into a full year and a full household. Only years with published figures are shown. Intervening years are neither estimated nor interpolated.

A single-person household pays around CHF 5,580 a year in 2026. A family of two adults and two children pays around CHF 14,110 a year, before the deductible and the co-payment are added. Against the year 2000 that is an increase of 148 and 145 per cent respectively.

Wages and prices did not rise anywhere near as fast over the same period. The premium is also a per-head charge: it grows with the number of heads in the household, not with income. That is why every increase hits families and low incomes first.

The premium is not all of it

The chart further up shows the premium only. The deductible and the co-payment are not in it. Anyone who sees a doctor pays on top.

The ordinary deductible is 300 francs a year; children pay none. Above it comes the co-payment of 10 per cent, capped at 700 francs per adult and 350 per child, and at 1000 for all the children of one family together. Maximum cost-sharing therefore comes to 1000 francs per adult per year.

In the worst case the single-person household pays CHF 6,580 instead of CHF 5,580. The family of two adults and two children pays CHF 16,810 instead of CHF 14,110.

The hospital contribution of 15 francs a day is not counted here. It has no annual ceiling, so a worst case including it would no longer be a number. Choosing the highest deductible of 2500 lowers the premium and raises maximum cost-sharing to 3200 francs per adult.

This is where the system strips people of capital. The bill arrives when someone is ill, which is exactly when their ability to pay is lowest. The bill becomes a debt enforcement, the enforcement becomes a certificate of loss, and the certificate becomes a debt many never climb out of.

Measured against the wage

The median gross wage for a full-time post was CHF 7,024 a month in 2024, about CHF 84,288 a year. That is the wage in the middle: half earn more, half earn less.

A single-person household therefore works around 24 days a year for the premium alone. A family of two adults, two children and one median wage works two full months for it, and almost two and a half in the worst case.

That is the difference between a tax and a per-head premium. A tax would be the same share of the wage for both households. The per-head premium is not: it does not know the wage at all, it only counts heads.

What the per-head premium does

Anyone who does not pay the premium faces debt enforcement. Since 2012 the cantons have had to cover 85 per cent of outstanding premiums and cost-sharing once a certificate of loss exists. Between 2012 and 2019 the cantons paid insurers almost 2.5 billion francs this way.

Some cantons additionally keep a list of defaulting premium payers. Anyone on it is reimbursed for emergency treatment only. Several cantons have since abolished the instrument, but it remains lawful. In Ticino, one person in twenty was most recently on the list.

At the end of 2017 an HIV-positive man in the canton of Graubuenden died of an AIDS-related illness after his insurer refused to pay for the therapy, because he was on the list.

This did not happen in a poor country. It happened in one of the richest in the world, a country that advertises its top-tier medicine as a competitive advantage. A state that puts people on a list so that treatment can be withheld from them, and calls that fighting abuse, has no business calling itself civilised.

This is the other side of the per-head premium. A bill that does not ask about income creates debt among those who cannot pay it. The public purse ends up paying anyway, only later, more expensively, and through debt enforcement.

How others do it

The United Kingdom, Australia, New Zealand, Sweden, Italy and Spain fund basic care from taxation and treat people without a bill at the door. Germany and France levy a percentage of the wage. Both forms are tied to income.

Switzerland is the exception. Its premium is tied to no assessment base at all. It counts heads. The apprentice and the bank director in the same canton pay the same amount.

No model is without edges. Germany applies a minimum assessment base to voluntarily insured members: in 2026 an income of 1,318.33 euros a month is assumed, so anyone earning less or nothing still pays around 278 euros from it. France tied access to residence rather than employment in 2016, and funds it through a levy on all income, capital included.

Even with that edge the difference holds. The German minimum contribution is below the Swiss adult premium, and above the minimum it rises with income. The per-head premium has neither a minimum nor a rise; it has one amount. A self-employed person having a bad year pays the same in Switzerland as in a good one.

The point is not that Switzerland spends more. Several countries spend a similar share of their economic output on health. The point is who carries the bill and what it is measured against.

What the system delivers

One objection belongs here, before someone else raises it: Switzerland is at the top on outcomes. In 2023 it led, together with Japan, Spain and Israel, a group of 27 OECD countries where life expectancy at birth exceeded 80 years. On avoidable mortality it was lowest, together with Luxembourg.

That is not an argument for the per-head premium. It is an argument for the doctors, the hospitals and the nursing staff, and they remain the same after a change of system. Japan and Spain reach the same leading group without levying a premium that knows nothing of the wage.

The question is not whether Swiss medicine is good. It is good. The question is who carries the bill, what it is measured against, and what happens to those who cannot pay it.

Position

Switzerland needs a public health system on the model of the United Kingdom, Australia and New Zealand: tax-funded, free at the point of treatment, for holders of European and Swiss passports. Anything beyond that the market insures privately, at prices that are affordable without subsidy.

This is not deregulation but a change of system. The per-head premium disappears. Funding runs through taxation and therefore follows ability to pay rather than the number of heads in a household. The deductible, the co-payment and the premium subsidy fall away, along with the administration they require.

The step is smaller than it looks. A substantial part of the health system is already financed by the cantons out of taxation, and coverage was practically complete at 97 per cent before the obligation. What is missing is not the reach but the form of funding.

The timeline

Sources

• Bundesratsbeschluss vom 16.1.1995 ueber das Ergebnis der Volksabstimmung vom 4.12.1994
• Bundesgesetz ueber die Krankenversicherung (KVG) vom 18.3.1994
• Bundesgesetz ueber die Kranken- und Unfallversicherung (KUVG), Volksabstimmung 4.2.1912
• BAG, Praemiengenehmigung 2026 (23.9.2025)
• BAG/priminfo, Mittlere Praemie
• BAG, Statistik der obligatorischen Krankenversicherung
• Geschichte der Sozialen Sicherheit (BSV), Die Krankenversicherung in Zahlen
• SRF, KVG-Reform: 30 Jahre Krankenversicherung
• Historisches Lexikon der Schweiz, Spital
• Buergerspital Basel, Geschichte
• Medizinhistorisches Zuerich (UZH), Das erste Zuercher Spital
• SRF, Saeumige Praemienzahler: Nationalrat will schwarze Liste beibehalten (16.12.2021)
• NZZ, Die Front der schwarzen Liste broeckelt (2024)
• Blick, Jeder 20. landet auf der schwarzen Liste (2024)
• BAG, Praemien und Kostenbeteiligung (Franchise, Selbstbehalt, Spitalbeitrag)
• BFS, Schweizerische Lohnstrukturerhebung 2024 (Medianlohn CHF 7024)
• OECD, Health at a Glance 2025
• GKV, Mindestbemessungsgrundlage 2026 (1318.33 Euro pro Monat)
• Assurance Maladie, Protection universelle maladie (PUMa)
• OECD, Health at a Glance 2025 (Lebenserwartung, vermeidbare Sterblichkeit)