Federalism in Health and Social Care in Switzerland

Abstract

Besides its high quality and high costs, the Swiss health system is mainly characterized by its federal structure. The cantons bear not only the strongest responsibilities, but also pay more than 80% of the public money going into the system. Thus, despite some more recent attempts to improve coordination, the system is rather fragmented. This fragmentation has so far prevented the formulation of a consistent national health policy. In the following chapter, first the formal allocation of responsibilities and the financing system are described (Section 1). Section 2 discusses the underlying reasons for the distribution of tasks among the different governmental levels, its legal foundations as well as recent policy developments. In Section 3, the effects on equity, quality, and efficiency of the health system are investigated. We conclude with some remarks on the tensions and likely future development of the Swiss health system (Section 4).