The Federal Council recommends the adoption of the proposed amendment to the Health Insurance Act (Krankenversicherungsgesetz, KVG), which seeks to implement a standardized financing mechanism for healthcare benefits, during the upcoming vote on 24 November 2024. Under the proposed amendment, all services covered by the compulsory health insurance (obligatorische Krankenpflegeversicherung, OKP), including outpatient, inpatient, and nursing home care, shall be financed according to a uniform distribution key. The primary objective of this reform is to eradicate existing incentives that have historically contributed to elevated hospitalization rates and rendered outpatient treatments financially less attractive.

Under the current framework, health insurers bear all the costs of outpatient treatments, while the cantons are responsible for financing at least 55 % of inpatient treatment costs through taxation. This existing system imposes a financial burden on policyholders, as the proportion of costs financed by premiums continues to escalate, while the proportion financed by taxes declines. The proposed reform stipulates that, henceforth, the cantons shall finance at least 26.9 % of all health costs, while health insurers will cover a maximum of 73.1 %. This adjustment aims to achieve a more equitable distribution of the financial burden and to reduce the overall premiums charged to policyholders.

Effective from 2028, this financing model shall apply to both outpatient and inpatient treatments, and from 2032, it will also be extended to home care and nursing services. A uniform tariff structure will be collaboratively developed by the cantons, health insurers, and service providers, which will improve planning and foster the provision of outpatient care. The reform is also expected to improve the coordination of healthcare services, which could lead to long-term cost savings.

While the reform is broadly supported by the Federal Council, the Parliament, and numerous health organizations, labor unions have raised concerns about the potential for excessive power to be conferred upon health insurers. They have raised alarms regarding the likelihood of rising premiums and the deterioration of working conditions within the caregiving sector. In response to these concerns, the Federal Council and Parliament contend that the reform is designed to alleviate the financial burden of premiums and to mitigate unnecessary hospitalizations.

Fore more information, see here.