For members


How does the Swiss healthcare system compare with the US?

In most aspects, Switzerland and the United States are vastly different countries. In terms of their healthcare systems, there are some similarities, but huge disparities as well.

How does the Swiss healthcare system compare with the US?
Not everyone in the US has access to healthcare. Photo by SEBASTIEN BOZON / AFP

In some ways, Switzerland’s healthcare system is more similar to USA’s than to that of its European neighbours.

The main difference between the Swiss and European health systems is that the latter is public, while the former is private.

It is this private versus nationalised (or, as some say, socialised) aspect that brings Switzerland closer to the USA’s system than to Europe’s.

That is one similarity, but there is another as well.

For instance, both countries’ systems are very costly: at $12,318 per person (10,941 francs at a current exchange rate), the US spends more than any other country in the world on healthcare. Switzerland is in the third position, with $7,179 (6,377 francs) per capita.

So much for the similarities; now let’s look at the main differences.

Employer versus individual

Most US residents who are employed get their health insurance through their company.

In Switzerland, on the other hand, individuals are responsible for purchasing their own policies from one of the dozens of insurance providers.

It is difficult to say which approach is better; however, not having one’s health insurance tied to (and dependent on) a specific employer means that a person won’t be left without a coverage if he or she loses their job.

Mandatory versus optional

While in the United States health insurance is optional, in Switzerland the basic coverage (KVG in German and LaMal in French and Italian) is obligatory.

The consequence of this system (as mentioned above) is that if a US person becomes unemployed, losing the company health plan in the process, and chooses not to purchase their own coverage, he or she is not insured.

While they will be treated in emergencies, they will have to pay the cost of medical care out of their own pocket.

In Switzerland, such a situation won’t happen.

Did you say ‘costs’?

Both Switzerland and the US have a high standard of health care, in terms of facilities, technology, and general services.

However, the difference in prices for the same medical treatments is tremendous.

For instance, the average price for a knee replacement surgery in the USA is $35,000 (about 31,000 francs). 

The cost of the same procedure in Switzerland varies by cantons and hospitals, but the highest price is 16,900 francs. 

Insurance will pay most of this cost, but for people in the US who have no health coverage and are not very wealthy, paying this amount out of pocket often means going into debt.

In fact, statistics show that nearly a quarter of Americans have medical debt — which means they are not able to pay their health bills out of pocket.

Such a situation cannot happen in Switzerland.

Some Americans have no insurance and no money to pay exorbitant medical bills. Photo: Pixabay

Access to health services

This is another area with a wide gap between the two countries.

According to a Harvard University publication, “the current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities.” 

Also, the same publication points out that many health insurance companies in the US “restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer.”

This practice discourages care deemed appropriate by a physician, it added.

In Switzerland, on the other hand, such a scenario is unrealistic.

Even the National Institutes of Health, an official US government body, noted in a report that the Swiss system “offers a high degree of choice and direct access to all levels of care with virtually no waiting times.” 

And speaking of waiting time

According to a survey by the Organisation  for Economic Cooperation and Development  (OECD) on how long patients in various countries typically wait for an appointment, Switzerland has among the shortest waits for medical tests and procedures, as well as for specialist visits.

The survey indicates that it is rare for residents of Switzerland to have to wait many weeks to be seen by a doctor or to schedule a surgery, except in exceptional cases.

“The share of people reporting that they sometimes, rarely or never get an answer from their regular doctor’s office on the same day is low in Switzerland (12 percent) but high in the United States (28 percent),” OECD reported.


In the United States, a written referral from a physician is required for a patient to see a specialist.

If a patient sees a specialist without a proper referral, insurance company may refuse to pay the bill.

In Switzerland,  you can consult specialists without a referral from your doctor — unless your insurance policy states otherwise.

In principle, KVG / LaMal covers “unreferred” specialist visits, provided the doctor is officially recognised and not an unlicensed, back-alley practitioner.

However, there are exceptions to this rule.

If you don’t have a ‘regular’ plan  but a cheaper, more restrictive policy (such as HMO, Telmed, or family doctor model), you are limited in your unreferred specialist visits.

READ ALSO: How to see a specialist doctor in Switzerland without a referral

Other differences

While the Swiss have the world’s highest life expectancy — due in large measure to its efficient and accessible healthcare system — “Americans are living shorter, less healthy lives because our health system is not working as well as it could be,” according to a report from The Commonwealth Fund, an organisation that researches global healthcare issues. 

As this OECD chart indicates, life expectancy in the US is even below China’s.

The Commonwealth Fund pointed out that the US health system “can seem designed to discourage people from using services… Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”

Member comments

Log in here to leave a comment.
Become a Member to leave a comment.
For members


From condoms to vaccines: The most controversial rulings by Switzerland’s highest court

The Swiss Federal Court, the highest judicial authority in the country, has ruled on some highly contentious issues over the years.

From condoms to vaccines: The most controversial rulings by Switzerland’s highest court

Before we get to actual cases, it is important to understand how Switzerland’s justice system is set up.

There are different court levels.

When people file their cases with the legal system, their first contact are district courts, which group together judiciary authorities by local areas.

Many Swiss towns are too small to have their own courts, so a district court is just that — a court that covers several neighbouring communities.

If, say, you become involved in a civil lawsuit, a divorce case, or any kind of litigation or dispute, the case will be first be heard at the district court.

Most often, its rulings are final.

However, if you are not happy with the verdict of your district court, you can appeal it within 30 days, at which point your case will go to the higher judicial level, that is, the cantonal court.

Each canton has its own high court — Switzerland’s second most important judicial entity hierarchically.

Besides criminal cases, cantonal high courts hear civil claims, and there are also courts on cantonal level for administrative cases.

The next is the Federal court, the highest judicial authority in Switzerland.

Headquartered in Lausanne, it is the final instance on all appeals against decisions of the highest cantonal courts, as well as the three other federal courts, which deal with criminal, administrative and patent cases, respectively.

This chart shows how the judicial system is organised in Switzerland. 

READ ALSO: What you should know about Switzerland’s courts

This means that by the time a case (that is to say, the appeal) comes before federal judges, it has already been ruled on by lower courts.

This is what happened in these three recent controversial cases as well.

The condom

You might think that taxpayer-funded federal court should not spend its valuable time (and public money) on a case involving a condom, but it has done so nevertheless.

As Swiss media reported, on September 14th, the highest court ruled on a case that has been heard in the lower courts in Zurich since 2017.

It involved a young man (19 at the time), who took off his condom during sex with an 18-year-old woman, without, however, informing her or asking for her consent to do so.

This practice is called ‘“stealthing’ in English.

The woman filed a complaint in a district court of Bülach (Zurich) and, after a series of rulings and appeals through higher courts (see above), ended up before the federal tribunal.

The case took so long because it had many twists and turns.

Stealthing is not punishable by Swiss law, which is why both the district and cantonal court acquitted the young man

The Federal Court  also acquitted him, but reassessed the case from the perspective of sexual harassment. That ruling had stuck, and the young man must now pay a 2,500-franc fine, in addition to 7,200 francs in court costs.

Forced vaccine

In the most recent case, which The Local reported last week, the Federal Court sided with the man who wanted his ex-wife to be forced to vaccinate their two children against measles.

The mother, an anti-vaxxer, had refused to do so, and the long-winded battle between the parents, which made its way through the lower courts, eventually landed in the federal tribunal.

As it had done in several previous similar cases when parents didn’t see eye to eye about vaccinating their children, the court followed the  public health guidelines, which are clearly in favour of childhood immunisations.

Therefore, judges sided with the father, giving the mother an order to immunise her children against measles.

Parents can be made to vaccinate their children court ruled. Photo by charlesdeluvio on Unsplash

Assisted suicide

In another recent case, from June, the court acquitted a Swiss doctor, Erika Preisig, who was charged with homicide for helping a mentally ill patient die in a Basel assisted suicide clinic. 

Previously, predominantly people suffering from physical ailments could benefit from voluntary suicide, which is legal but well-regulated in Switzerland.
However, Preisig was charged because she had violated the previous Federal Court ruling, from 2006, which required a psychiatric evaluation on the patient before helping them die.

In June, the court overturned its old decision, finding that although Preisig had not obtained a psychiatric report, she had studied the medical records, had intensive discussions with the patient, questioned relatives, and obtained a second opinion. The mentally ill person was understood to have made a well-considered decision and was capable of judgement. 

The Federal Court had therefore confirmed that Preisig could assume, even without a psychiatric expert opinion, that the patient had a permanent wish to die, as she suffered from an incurable, permanent, severe mental impairment.

READ ALSO: What to know about Switzerland’s latest court judgement on assisted suicide


While obtaining Swiss citizenship is a long and complicated process, and rejections at communal level are often made arbitrarily, the Federal Court had sided with applicants on several occasions.
For instance, in 2018, the court ordered the commune of Trimmis in canton Graubünden to grant Swiss citizenship to an Iranian refugee who had lived in the community for 30 years. 

It reversed a ruling made previously by the lower court, which sided with local authorities who denied the man the right to become Swiss.