1

The Swiss health insurance system is a halfway-house between a social insurance and a private health insurance system. Insurance is compulsory and managed by a range of non-profit private health insurance companies (sickness funds) which officially compete with each other and cover an identical benefit package.Insurance premiums do not depend on income and vary according to the canton in which the insured person lives and the average risk of the client base for the insurer ( community rating). The model provides the citizen with total freedom in choosing the service provider and health insurer in the canton within which they live. Insurers may offer products with limited freedom of choice in return for a reduction in the insurance premium.An appraisal of the regulatory role of this complex insurance model, which represents a compromise between market mechanisms and state regulation, and which is subject to a regressive financing, has shown that the objective of equity in access to health care has been broadly achieved whereas that of bringing cost increases under control has not. Major reforms of the system are being discussed in Parliament, but their successful outcome may well be called into question by the differences in the objectives of the main stakeholders and by the federalism and direct democracy that characterise the Swiss constitutional landscape.