The Swiss Federal Council approved a report in fulfilment of Parliamentary Postulate 24.3224 Poggia "Implementation of the HIA. For the organisational freedom of the cantons", concluding that the introduction of cantonal cost-equalisation funds would result in additional complexity and higher costs compared to the current system. The postulate had mandated the Federal Council to examine the advantages and disadvantages of establishing a cantonal cost-equalisation fund that would act as the sole insurer for all persons insured within a given canton. Under the proposed model, the fund would finance costs charged to the HIA, set and collect premiums, and delegate administrative tasks, such as invoice review and handling of legal disputes, to existing health insurers.

The Federal Council concluded that the proposed model was not appropriate. First, it would increase complexity for insured persons, as more actors would be involved in the system. Second, the establishment of one or more cantonal equalisation funds would raise administrative costs, with a direct impact on premiums. Third, the multiple roles that cantons would assume, i.e., as members of the fund's governing bodies, owners of public hospitals, and approval authorities for tariff agreements, would inevitably give rise to conflicts of interest.

For more information, see here.