Swiss popular initiative for a single health insurer… once again!

Abstract

The article describes a recent Swiss popular initiative, aiming to replace the current system of statutory health insurance run by 61 competing private insurers with a new system run by a single public insurer. Despite the rejection of the initiative by 62% of voters in late September 2014, the campaign and ballot results are interesting because they show the importance of (effective) public communication in shaping the outcome of a popular ballot. The relevance of the Swiss case goes beyond the peculiarities of its federalism and direct democracy and might be useful for other countries debating the pros and cons of national unitary health insurance systems versus models using multiple insurers. After this electoral ballot, the project to establish a public sickness fund in Switzerland seems definitely stopped, at least for the next decade. Insurers, who opposed the initiative, have effectively fed the "fear of change" of the population and have stressed the good outcomes of the Swiss healthcare system. However, the political pressure favoured by the popular initiative opened a "windows of opportunity" and led the federal Parliament to pass a stricter regulation of health insurers, improving in this way the current system.

Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage

“…Although there are several articles that exploring the possibility of a decrease in solidarity in Switzerland and elsewhere following social health insurance reform, [16][17][18] our results show persistence of a strong and practical notion of solidarity as reflected by the priority placed on providing basic protection for everyone. When a level of coverage was described as basic, however, participants initially considered including it as the default.…”

Exploring societal solidarity in the context of extreme prematurity

“…The Swiss healthcare system is thought to reflect an egalitarian sentiment where solidarity plays an important role in public discourse. In addition, the health system and the current social health insurance system are greatly valued by patients and the population as a whole [20,21]. Hence, solidarity is something that is shaped within a society over time and can vary in different contexts [18].…”

Consumer-driven health insurance in Switzerland, where politics is governed by federalism and direct democracy

“…As a result, the percentage of those supporting the initiative fell constantly over time. This decline in supporters, observed in the polls, shows again how a majority in favour of the initiative (until June 2014) can be gradually transformed into a majority against it (De Pietro & Crivelli, 2015), with 61.8% of voting people finally rejecting the initiative. Yet there is another explanation which invokes Hirschman's theory: the opportunity of exit (towards sickness funds with lower premiums, higher deductibles or managed care contracts) takes strength away from voice.…”