Health insurance funds: 5% increase and proposals evaluated by experts

Context

TL;DR

• In 2027 the national monthly premium will increase by 5%
• Three independent experts assessed the proposals
• LAMal administrative costs: around 4% of premiums
• Prevention accounts for around 1.5% of healthcare spending

Key facts

• National increase → 5% in 2027
• Social insurance management costs in France → 3%
• Healthcare expenditure financed directly in France → 97%
• Management costs of private insurance in France → 21%
• LAMal administrative costs → around 4% of premiums
• Prevention in Switzerland → around 1.5% of healthcare spending
• Savings from catalogue checks → around 150 million francs per year
• Estimate for Ticino from 2029 → half of citizens with premium reductions

In 2027 the national monthly premium will increase by 5%. Last week, the new increase in health insurance premiums for next year was announced. Numerous user proposals were submitted to the dialogue community; three independent experts examined them and commented on some of them.

State-run fund and management costs

A proposal envisions a state-managed health insurance fund, with subsidies for policyholders. The possible advantage indicated by users is a lower premium: without the aim of generating profits or distributing dividends, management could cost less.

The comparison brought into the discussion concerns France. In social insurance, management costs are reported at 3%; 97% of healthcare expenditure directly finances medical services. For private insurance, management costs amount to 21%. The proposed conclusion is therefore that the public sector would be much more efficient.

Christina Vetsch-Tzogiou, from Zurich University of Applied Sciences (ZHAW), shifts the focus, however, from profit to the cost structure. For mandatory health insurance under LAMal, health insurers may not make profits, while administrative costs represent around 4% of premiums. Cost growth depends mainly on the increase in expenditure per person treated, linked to medical progress, the growing use of services and possible overtreatment. In this assessment, a single fund would probably not solve the problem.

Prevention and organization of care

The proposals collected also call for stricter laws in the food sector, from a sugar tax to Nutri-Score, as well as a ban on highly processed products and limits on margins for healthy products. The promotion of sport and early, systematic screening activities for certain diseases are also mentioned.

Cécile Grobet, from ZHAW, recalls that Switzerland allocates around 1.5% of healthcare expenditure to health promotion and prevention. In her view, a national strategy, clear objectives and an evaluation of costs and benefits are needed. The effect on premiums in the coming years would not be conclusive, but prevention could contribute in the long term to reducing the number of sick people.

Igor Francetic, from SUPSI, considers monitoring specializations and specialists' remuneration a way to control volumes and prices. Revaluing primary care, on the other hand, would not necessarily make this sector more attractive to medical graduates.

For readers who want to explore the insurance framework, the website provides guida LAMal.

Operational details

What this means in practice for those looking at Ticino

For a cross-border commuter, the most concrete geographic reference in the source is the Canton of Ticino. The assessment related to the canton says that, from 2029, it is estimated that half of citizens could benefit from premium reductions. The figure describes the scenario for reductions, while 5% remains the national figure for 2027.

This distinction changes how the news is read. The 5% concerns the national monthly premium; the estimate for Ticino instead concerns the possible distribution of premium reductions. These are two different levels: the first signals the announced increase, the second shows how broad the affected population could be. For those who work across the border, the two figures should therefore be kept separate.

Costs, redistribution and timing

The table separates five levers that may appear equivalent in the debate, but are not. The state fund concerns organization and the absence of profits and dividends; the income-based premium concerns the distribution of financing. Prevention works over the long term, while control of specializations and remuneration targets the volumes and prices of services. Verification of the LAMal catalogue, on the other hand, addresses the effectiveness, appropriateness and cost-effectiveness of the services included.

For those who work across the border and follow the cost of living in Ticino, the figure to monitor is therefore not a single percentage. It is necessary to distinguish the announced increase, any reduction in premiums and the effect of the reforms. The confronto del costo della vita can complement this reasoning, without replacing the reading of the assessments reported.

Recommended tools

For an updated estimate, use the net salary calculator and the CHF-EUR exchange comparator.

Key points

How to use expert assessments

The news can be turned into a structured verification, without assigning the proposals any additional amounts or rules. For a cross-border worker following the issue in Canton Ticino, it is useful to separate the national figure, the possible reduction in premiums and structural reforms.

A five-step method

1. Fix the national figure. Write 2027 and a 5% increase in your worksheet. Use it as an editorial starting point, not as an individual calculation: the news concerns the national monthly premium.

2. Classify the proposal. Put the state-run insurer in the management column; the income-based premium in the distribution column; prevention, specialists and the LAMal catalogue in the columns dedicated to system reforms. This separation prevents you from confusing a different distribution of costs with a reduction in them.

3. Verify which problem is being addressed. For the state-run insurer, set Christina Vetsch-Tzogiou's assessment alongside the claim that there are no profits and dividends: under LAMal, profits are not permitted and administrative costs account for approximately 4% of premiums. For the income-linked premium, record instead the assessment that costs would change little and would be distributed differently.

4. Put the proposals in chronological order. The increase figure concerns 2027; the estimate of reductions in Ticino starts in 2029; prevention is described as a long-term contribution and not as a definitive solution for premiums in the coming years. The catalogue reviews, on the other hand, have an estimated saving of about 150 million francs per year.

5. Conclude with the experts' criteria. For LAMal benefits, consider effectiveness, appropriateness and cost-effectiveness; for prevention, look at clear objectives and the relationship between costs and benefits; for specialists, observe the control of volumes and prices. A cross-border worker can thus read the Ticino figure without turning the estimate concerning half of the citizens into an individual amount.

The final worksheet should keep three levels distinct: the announced fact, the expert's assessment and the possible consequence. This is a way to remain faithful to the source and not attribute an additional procedure to the reduction in premiums. To complete the check of your budget, open the calcolatore fiscale.

Source: rsi.ch