Health Insurance Act

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Basic data
Title: Federal Law on
Health Insurance
Short title: Health Insurance Act
Abbreviation: KVG
Type: Federal law
Scope: Switzerland
Legal matter: Administrative law
Systematic
legal collection (SR) :		 832.10
Original version from: March 18, 1994
Entry into force on: January 1, 1996 (AS 1995 1328)
Last change by: AS 2016 2265 (PDF; 262 kB)
Effective date of the
last change:		 1st July 2019
Please note the note on the applicable legal version.

The Health Insurance Act ( KVG ) in Switzerland serves to financially protect all sections of the population in the event of illness. According to the KVG, all persons residing in Switzerland must belong to a health insurance company . The KVG is the most important health law in Switzerland because it not only regulates health insurance, but also numerous other areas of health care.

There is competition among health insurers. Each insured person can decide for himself which of the 61 health insurance companies currently recognized by the federal government (as of September 2014) he would like to be insured with. The health insurance companies must offer the same, very extensive "catalog" of services (the so-called compulsory health insurance or basic insurance ). This enables policyholders to directly compare the premiums of the individual companies.

prehistory

The KVG replaced the old Health and Accident Insurance Act of 1911 (KUVG). Under this, the insurance premiums were graduated according to the entry age. The boys were offered cheap insurance premiums, but the premiums were still higher than the health risk. In this way, the insurers were able to set up "old-age provisions" to cover the higher health expenditure in old age. If an older person took out insurance, the health insurance premium was correspondingly higher because the necessary retirement provisions were not made. Health insurance companies also had the opportunity to make reservations about existing illnesses and insured persons over a certain age did not have to be admitted. Since the health insurance premiums could also be deducted from tax, most Swiss took out insurance at a young age, even without compulsory insurance.

The disadvantage of this system was that due to the lack of freedom of movement - the retirement provisions could not be transferred to the new insurance when changing insurance - the mobility of the insured was severely restricted in old age. These so-called “golden shackles” inhibited the intensity of competition in the health insurance system. However, it should be mentioned that the competition was definitely played out among the young people who were still uninsured - but this also led to undesirable risk selection . Another disadvantage of the old system was that the increasing burden on households due to health insurance premiums was countered by subsidies to health insurers, which benefited everyone - and thus also the wealthy - (so-called watering can principle ).

The legislature pursued three main goals with the new KVG: Firstly, the solidarity between insured persons with different risk of illness and with different incomes should be strengthened. Second, medical care of high quality but affordable for everyone should be ensured. Third, cost-containment competition mechanisms within a defined regulatory framework should contribute to a moderate cost development.

The new KVG was adopted in the referendum of December 4, 1994 with 51.8% yes-votes. The Federal Council put it into effect on January 1, 1996.

content

Basic insurance is compulsory for everyone (compulsory insurance); previously 97% of the population were voluntarily insured. The health insurance companies are still not allowed to differentiate the insurance premiums according to the risk of illness of the insured. What is new is that the insurance premiums that are graduated according to entry age are no longer permissible and have been replaced by a regime with head or unit premiums. Only geographical differentiations are still allowed. The cantons in particular are self-contained premium regions. This prevents the cantons with high health expenditure, which largely reflect the cantonal health policy, from "exporting" it to the other cantons. But three premium regions are also permitted within the cantons. The health insurance companies are obliged to offer everyone the same premium for basic insurance within a premium region. In addition, there is absolute freedom of movement for the insured, i. In other words, the health insurance companies must offer every individual insurance cover without reservation.

In contrast to Germany and Austria , the list of services subject to statutory health insurance is less comprehensive in Switzerland. This is especially true for dentistry and elderly care . In the case of medical services, the KVG has an open service catalog, i. H. there is no conclusively defined catalog of services (no positive list). However, the KVG requires that the services provided by doctors are "effective, appropriate and economical". If there are doubts about a new or controversial service, it will be examined by the Federal Commission for General Services and Fundamental Questions (Service and Fundamental Commission ELGK). The Federal Department of Home Affairs (FDHA) then determines whether the audited service is subject to health insurance. In contrast, positive lists are defined for the other services.

With the intention of reducing the risk selection , which is lucrative due to the capita premiums, a risk structure compensation (called risk compensation in Switzerland) was introduced between the health insurance companies. Today, this only takes into account the age and gender of the insured. However, these factors explain only a small part of individual health expenditure. Risk selection therefore remains an attractive strategy for health insurance companies. It has been shown that health insurance companies set up their own new subsidiary insurances in order to actively acquire good risks (those with a low probability of illness). Since the bad risks are apparently much less mobile and remain loyal to their health insurance company, there is still considerable risk selection.

The head premiums (uniform health insurance contribution) prescribed since 1996 place a particularly heavy burden on the lower income brackets and families with many children . So-called premium reductions, which are based on the taxable household income, provide targeted relief. The premium reductions are financed from general tax revenues. Since the insurance benefits of the compulsory health insurance per capita have grown by an average of five percent a year since 1996 and household incomes are more or less stagnating, the number of insured persons with premium reductions has increased considerably since the introduction of the Health Insurance Act. Whereas in 1996 around 23 percent of all insured persons were entitled to receive premium reductions, in 2003 it was already 32.8 percent. In absolute numbers, this is an increase from around 1.7 million to 2.4 million insured persons or from around 820,000 households to 1.3 million households.

A direct intervention in the competition takes place in the inpatient area through the introduced obligation to cantonal hospital planning. On the basis of needs-based planning, the cantons should ensure that the needs are met, but at the same time that there is no overcapacity. This gives the cantons the opportunity to control the inpatient sector, but must pay at least half of the operating costs of public and publicly subsidized hospitals.

Revisions

Shortly after the law was introduced, the need for reform became apparent. On September 21, 1998, the Federal Council passed its dispatch on the first partial revision of the KVG. The key points of this proposal were cost containment and solidarity. With selective changes in the law, deficiencies identified in practice in the areas of premium reductions, the relationship between the insured and the insurer, benefits, cost sharing, supervision and cost control were corrected. The revision proposals were discussed by the Federal Assembly and adopted in the 2000 spring session.

A second revision has been in progress for years, but is encountering great difficulties because of the conflicting interests.

See also

Web links