The Swiss electorate has rejected the idea of a single public health insurer on several occasions. Most recently, it clearly rejected the initiative to introduce a single health insurance scheme nationwide in the referendum of 28 September 2014. The 61.8% 'No' votes thus reflect the population's continuing clear endorsement of the competition-based healthcare system whose funding is based on social solidarity. A popular initiative was launched in western Switzerland in autumn 2017 to create a single health insurance scheme for each canton. The initiative ultimately failed to secure enough signatures. A pending initiative by the Canton of Neuchâtel recasts the idea, calling for a single health insurer at cantonal or regional level. However, its chances of success are slim.
A state-run health insurance provider would set a standard premium for all insured persons in the canton in question. Existing health insurers would be consigned to the role of checking and paying bills. CSS rejects the idea of a single health insurance scheme for all Switzerland – as well as at the national and regional level. Competition between health insurers currently leads to high quality and efficient invoice checking, which works in favour of the premium payers by preventing benefits from being paid unnecessarily. In addition, insured persons have a wide range of innovative products and services to choose from and enjoy premium discounts when opting for an alternative insurance model. Under a system monopolised by a single general health insurer, the insured persons would lose this freedom of choice and thus the possibility afforded them by law of changing health insurance. With a cantonal health insurance scheme, they would only be able to change between what would effectively be insurance clearing houses, but would have no option other than to stick with the cantonal health insurer even if it was badly managed and premiums increased drastically. Yet it is precisely the threat of accelerated cost growth that looms large in this scenario, as a single cantonal health insurance scheme would have no incentive to offer attractive premiums and the service providers that profit from high medical tariffs would be represented in the organisation’s managing body and thus have a say in setting premiums. Moreover, it can be assumed that administration costs would rise in the case of a monopolist general health insurer without competition. And, lastly, the aim of a single health insurance scheme is to massively reduce its reserves, which would in turn jeopardize the institution’s financial stability given even the slightest misjudgement of how costs were likely to develop. The resulting financial imbalance could then only be corrected through a substantial increase in premiums or using taxpayers’ money.