Explaining policy stability and change in Swiss health care reforms

Abstract

The article investigates recent health reforms and reform attempts in Switzerland. A substantial reform, the revision of the health insurance law in 1994, is followed by a long period of refused reform proposals and incremental change. In order to explain policy change and policy stability in health policies, we apply veto-player theory to partisan and parliamentary debates on reform proposals of the health insurance from the end of the 1980s until today. Shifts in ideological positions of parties, especially with regard to the objective of solidarity, allowed for a new win-set in the 1990s that was at the base of the law revision. Since then, the win-set is empty as parties did not change their preferences. New and substantial reforms will only be possible, it is concluded, if the pivot player, the Christian-democratic party, changes its ideological positions to a significant extent. © (2009) Swiss Political Science Review.