Health insurance premiums: the net burden remained stable (cross-border guide)

Context

In brief

• 2027 premiums expected to grow between 4% and 5%
• Net burden: 6.5% in 2016 and 6.4% in 2023
• Standard premium: +19% between 2016 and 2023
• Median family: income from 88,875 to 95,760 francs

Key facts

• Period → from 2016 to 2023
• Sample → approximately 300,000 families across Switzerland
• Analysis → ten income categories
• Data → Helsana insured persons and anonymized official income data
• Assessment → net burden after state subsidies

Next week, Federal Councillor Elisabeth Baume-Schneider will announce the average growth of health insurance premiums expected for 2027. The expected increase is between 4% and 5%. The NZZ considers the interpretation of a generalized «blow» to be excessive. The topic directly concerns spending on health insurance, but the analysis primarily measures the actual weight after subsidies.

The comparison between premiums, income, and subsidies

Economists Stefan Felder, Stefan Meyer, and Kurt Schmidheiny from the Basel Center for Health Economics analyzed information from all Helsana insured persons. The data were cross-referenced in anonymized form with official income data. For the NZZ, the group carried out a special assessment of approximately 300,000 families across Switzerland, divided into ten categories, from the lowest to the highest decile.

The result concerns the net burden of health insurance bills after the deduction of state subsidies. Between 2016 and 2023, it remained stable across all income brackets. For a middle-class family, the share of gross income allocated to premiums was 6.5% in 2016 and fell to 6.4% in 2023.

This figure should be compared with the standard premium, defined by the source as that with the lowest deductible and free choice of doctor. That premium grew by 19% over the same period. However, the gross premiums for the median family increased by 11%, equivalent to 750 francs more per year. The median gross income rose from 88,875 francs in 2016 to 95,760 in 2023: the increase of 6,885 francs more than covered the increase in premiums.

The role of public support

A third element is represented by federal and cantonal subsidies, which rose by approximately 440 francs for the median family. More than half of the premium growth was therefore absorbed by the Confederation and the cantons. The NZZ also notes that in 2023, families with children paid on average no more than 8% of their gross income. In the lowest decile, without state support, the burden would exceed 20%; however, for many households, social support fully covers the premiums and reduces the share to less than 5%.

Operational details

National figures do not erase local differences

Average stability does not mean that every household has experienced the same evolution. The same analysis points to marked regional differences: premiums are higher in Ticino, in some regions of Romandie, and in Basel. In these areas, there are families with a net burden exceeding 10% of their gross income. In the rest of Switzerland, according to the NZZ conclusion, the weight of premiums has remained sustainable for the population, despite numerous complaints.

For the reader, the correct comparison involves three levels: gross premium, subsidy, and gross income. The standard premium is not enough to describe the actual expenditure, because many insured persons have switched to models with limited choice of doctor or higher deductibles. The net figure, on the other hand, incorporates public support. This explains why a nominal increase in the premium does not automatically translate into an equivalent growth in the share of income committed.

A family budget item to be read separately

The comparison concerns LAMal/KVG premiums and the cost of living in Switzerland, not other budget items. Mandatory health insurance premiums are distinct from direct federal tax, VAT, AVS/AHV, and LPP/BVG; in the snapshot examined by the NZZ, support comes from federal and cantonal subsidies. This distinction serves to avoid confusing a per capita bill with salary contributions or a tax. The Cantons matter because the analysis explicitly identifies the role of cantonal subsidies and regional differences.

The most delicate part concerns the recent period. Since 2024, premiums have grown more rapidly: the overall progression from 2024 to 2026 is similar to that recorded from 2016 to 2023, while incomes have only increased on average. The NZZ therefore admits that the burden may have become heavier. Linking subsidies to reference premiums should have covered a substantial part of the increases, but only future data will reveal how much the burden has actually grown.

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Key points

From national data to personal assessment

To turn the analysis into a personal assessment, it is useful to work with three values: gross premium, subsidy and gross income. The first step is to keep them separate. The amount to compare with income is not the isolated gross bill, but what remains after public support. This distinction makes it possible to assess the actual burden without confusing the increase in the premium with the increase in expenditure borne by the family.

A five-step sequence

1. At the time of the announcement scheduled for next week, note the average growth in premiums for 2027 and use it as a general reference, not as a substitute for the data concerning your household. 2. Report the gross premium and the state subsidy separately, so that you can reconstruct the net burden. 3. Indicate the insurance model observed: the standard premium corresponds to the lowest deductible and the free choice of doctor; the other models may provide for limited choice and higher deductibles. 4. Compare the net amount with the household's gross income and note the year, so that you can distinguish a change in income from one in premiums. 5. Read the result on two levels: the national and the regional. The analysis in fact separates the Swiss average from the areas where the net burden is higher.

For the period from 2024 to 2026, keep the comparison provisional. The progression of premiums was faster and incomes grew only on average; the role of subsidies, linked to reference premiums, will have to be measured using future data. The analysis itself defers the definitive assessment until this information becomes available.

When Baume-Schneider announces the average growth for 2027, update the comparison with the amount actually paid and the subsidy received. To relate income to the personal budget, use calcolatore stipendio.

Source: swissinfo.ch