“The first health insurance schemes (literally help funds or Hilfskassen) emerged from initiatives of entrepreneurs, trade unions or religious organizations. The coverage and scope of these schemes varied significantly across regions and principally provided financial support to workers and their families in case of illness, occupational disability or death. However, over time they also took on responsibility for the reimbursement of treatment costs (Leimgruber, 2011). By 1880, there were 1085 funds with a total of 209,920 insured, corresponding to about 7.5% of the Swiss population at the time. Insurance funds evolved in certain milieus and kept high entry barriers by limiting their services to workers, employees of a certain company, local inhabitants, or members of a church. Conditions and premiums varied significantly across cantons and even across municipalities (Muheim, 2000; Uhlmann & Braun, 2011).
“Until the late 19th century, almost all legislative responsibility in the area of health remained with the cantons (see section 2.4). However, in response to a typhoid epidemic in Valais in 1866, the Confederation started to play a role in health policy-making (Achtermann & Berset, 2006) and, in 1893, a predecessor organization of the Federal Office of Public Health (FOPH) was founded. In 1890, the federal government was given a constitutional mandate to legislate on sickness and accident insurance. However, the first attempt to introduce a system of health insurance failed in 1900, when a draft health and accident insurance law was rejected by referendum.
“After years of discussions and following substantial modifications to the initial proposal, the Federal Law on Sickness and Accident Insurance (KUVG/LAMA) was finally adopted by referendum in 1912. KUVG/LAMA required health insurance funds that wished to take advantage of federal subsidies to register with the Federal Office for Social Insurance and to abide by its rules. These rules included the obligation to provide a defined package of benefits, which included ambulatory care, drugs and hospital stays of limited duration, and to allow people a certain degree of freedom to change funds.”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
“In 1991, the Federal Council proposed a new Federal Health Insurance Law (KVG/LAMal) with three main aims (Federal Council, 1991): (1) to strengthen solidarity by introducing universal coverage and ensuring that people with low incomes receive subsidies for purchasing insurance; (2) to contain the growing costs of the health system by a host of measures targeting both the demand and the supply side; and (3) to expand the benefits basket and ensure high standards of health service provision. By Swiss standards, this law completed the legislative process relatively quickly: it was passed by Parliament in March 1994 and accepted in a public referendum in August of the same year. Since 1996, when KVG/LAMal came into force, it has been the most important legislative document regulating or influencing most areas of the health care system.
“The law made the purchasing of health insurance compulsory, introduced community-rated premiums, and made significant changes to the system of subsidies. Insurance companies were mandated to accept anyone applying to them for insurance. In addition, the law defined the general conditions by which health services are assessed for reimbursement and compelled cantons to plan acute care hospital and inpatient long-term care provision.
“While the law was successful in achieving (near to) universal coverage (see section 3.3.1), it has been criticized for having been ineffective in controlling the growth of health expenditures. Several revisions of the law have been made since the year 2000, primarily with the aim of containing the growth of expenditures (see section 6.1). Further reforms are planned with the aims of improving: the use of information in the health system; planning in ambulatory care; and health care provision for people with specific needs (see section 6.2).”
Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.
