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HEALTH INSURANCE

EXPLAINED: How the Swiss health insurance system is based on solidarity

Much has been said about Switzerland’s compulsory health insurance, most of it pertaining to its high — and continually growing — costs. But there is also another aspect of the scheme many people may not know about.

EXPLAINED: How the Swiss health insurance system is based on solidarity

For many people in Switzerland, the obligatory medical insurance is a sore point.

Premiums will likely rise by an average of 5 percent in the fall, and many people could even see their rates soar by more than 10 percent in 2023 — the sharpest hike in premiums in 20 years.

READ MORE: EXPLAINED: How Switzerland wants to cut soaring healthcare costs

While there are some ways to save money on a health plan, overall these policies are expensive, and you will hear many people grumble about this cost — even though Swiss healthcare system is known for its excellent level of care.

What you may have not known is that the whole scheme is based on the principle of solidarity, the extent of which is rare in other nations’ health insurance systems.

What exactly does this mean?

Rather than applying an individual approach to healthcare insurance, Switzerland’s system is based on the idea that all insured people form a group.

You can think of this system in terms of a huge pot to which each resident of Switzerland makes a contribution (that is, premium payments), so that in an emergency there are enough resources available to give someone the help they need when they need it.

This kind of ‘one for all’ approach takes precedence over the ‘to each his own’ attitude prevalent in many other countries.

“This means that even those who are in perfect health and never need to see a doctor pay their monthly premiums and thus indirectly provide for those who are ill and need more medical support”, according to a report by the WIRE research think tank.

In other words, all the people of the same age group living in the same canton pay the same premium, rather than different rates based on their income or other personal circumstances.

This applies only to the obligatory basic insurance (KVG / LaMal); supplemental insurances have a different rate base.

Under this system, “it is the task of the federal government, cantons, municipalities and health insurance companies to keep this group balanced<2, the report says. “That’s why decisions in the Swiss healthcare system are always taken in the interest of the group as a whole».

How did this system originate?

This principle of solidarity between the healthy and the sick has a long tradition in Switzerland and is even enshrined in the health insurance law.

“In practice, this also results in solidarity between young and old, because young people on average have little need of medical care, but the risk of illness increases with age”, the WIRE report points out.

“Uniform premiums also mean that there is solidarity between men and women, as the latter generally claim more medical benefits due to pregnancies and births and longer life expectancy,” it added.

How does this system compare with health policies in other countries?

According to the report, in an international comparison, the Swiss health system “displays greater solidarity than the US health system”, where anyone who is not insured has to pay for medical treatment out of their own pocket, “which is why many people get into debt”.

Switzerland’s approach is “also more liberal than Germany’s where health insurance premiums depend on a person’s income”.

Likewise, it is also more liberal than the health systems in France and the UK, “which rely more on fiscal contributions from the state”.

As for the question whether those countries’ health system are superior to Switzerland’s, the report notes that “this is doubtful because state healthcare systems financed by taxes are also forced to compensate for dwindling tax revenues, for example by increasing deductibles, which reduced the solidarity between the insured in different income bracket”.

READ MORE: How is Swiss healthcare system different from the rest of Europe?

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HEALTH INSURANCE

Reader question: Should I take out insurance before I go skiing in Switzerland?

With the start of the winter sports season in the Swiss Alps, many people probably think about the snow coverage, and not so much about insurance. But there are things you should definitely consider.

Reader question: Should I take out insurance before I go skiing in Switzerland?

To ski enthusiasts, the expression “hitting the slopes” conjures up images of gliding down snowy runs in vertical position, and arriving at the bottom of the hill only to take the ski lift up, and repeat the process  again.

But in its more literal sense, hitting the slopes means just that: you fall down on the ski slope and sustain more or less serious injuries.

And to use another skiing metaphor, once you have an accident, it will be all uphill from there.

Whether you are going to the mountains for a day or a longer vacation, it is wise to consider what kind of insurance policies you may need, just in case.

Even the most skilled skiers / snowboarders / snow shoers are not immune to occasional accidents. 

As a matter of fact, about 50,000 accidents are recorded in the Swiss Alps each winter, “the vast majority of which are linked to skiing and snowboarding, the two disciplines that also generate the highest costs”, according to Swiss National Accident Insurance Fund (SUVA).

That’s why accident insurance is a must

If you live permanently in Switzerland, regardless of whether you are a Swiss national or a foreigner, you already have an accident insurance — either through your employer if you work more than eight hours a week, or through your own policy if you are self-employed.

In some cases, accidents are covered under your compulsory health insurance (KVG / LaMal); this applies particularly to stay-at-home partners, children, students, and retirees.

The insurance will cover most of the accident-related costs,  including those of rescues by helicopters, though some policies will cover more or less of the expenses incurred.

A helicopter from the Swiss Air-Rescue REGA airlifts people injured in the mountains. Photo by FABRICE COFFRINI / AFP

These rescues are very expensive, so if you want to be fully covered for such cases, consider buying a supplemental insurance that includes some coverage for search and rescue costs, medical transportation, and repatriation (if you ski abroad).

Many (but not all) Swiss supplemental health insurance plans include unlimited coverage for ambulance transportation and repatriation to Switzerland for medical care.

READ MORE : Why getting rescued in the Swiss Alps could cost you thousands

What if you are a foreign tourist who has an accident on Swiss slopes?

The rule here is the same as for any medical emergency that can befall a foreign national in Switzerland.

“Nationals of other countries must have sufficient insurance to cover the costs of treatment in Switzerland,” according to the Federal Office of Public Health (FOPH).

If you are from an EU / EFTA state and have the European Health Insurance Card (EHIC), “you are entitled to receive medical care that is considered essential, given the type of treatment and the expected length of stay in Switzerland”, FOPH said.

“Essential care” means vital emergencies, rather than non-urgent treatments that can be safely postponed until you return home.

If you have an accident while skiing, the gravity of your injuries will determine whether they are “vitally urgent” or not.

Tourists from third nations, on the other hand, must have an adequate health insurance policy covering the costs of essential medical treatment due to illness of accidents.

READ MORE: Can a Swiss hospital refuse urgent medical care to a foreigner?

Lets hope this skier…doesn’t hit the slopes. Photo: Federico Tomasoni on Pexels

Accidents are obviously the most common occurrences on the slopes, but you may need other types of insurance as well.

For instance:

Personal liability insurance (Haftpflichtversicherung / responsabilité civile / la responsabilità civile)

This kind of policy would kick in if you or a family member cause an accident, injuring, even if inadvertently, another person.

Your liability insurance would pay the costs generated by this person’s accident — perhaps not medical ones if he or she has their own insurance (as mentioned above), but that of other damages, like broken skis and other equipment that got destroyed in the process.

Unlike KVG / LaMal and accident insurance, liability coverage is not compulsory, but it is very useful to have. It can be purchased from nearly every insurance carrier in the country.

READ MORE : What is Swiss liability insurance and do you need it?

Travel insurance

This too is optional but useful to have, especially with the option for cancellations of trips in cases of extraordinary circumstances (see below).

If you reserved the hotel, bought ski passes (and, if you come from abroad, booked a flight), and then extreme circumstances prevent you from making the trip, at least you will be able to get your money back.

What constitutes such events?

Illnesses and other health emergencies, death in the family, or loss of job.

Most policies will refund the money you spent but you will need to provide documentation such as medical certificates or other proof of one of the above emergencies.

This policy can also be purchased from insurance carriers or organisations like Touring Club Suisse (TCS).

Sports equipment insurance

This coverage is not as well-known as the previous ones, but it can prove useful if your skis, snowboards, and all the other winter-sports equipment breaks or is stolen.

Again, you can purchase this policy from an insurance company.

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