Health insurance premiums rise, but the burden on families remains stable (cross-border guide)

Context

In brief

• From 2016 to 2023, the net burden remained stable
• In 2027, expected premiums will rise by between 4% and 5%
• The middle class goes from 6.5% to 6.4% of gross income
• The standard premium rose by 19%

Key facts

The central finding of the analysis

From Zurich, the Neue Zürcher Zeitung relaunches the findings of a special assessment based on a study by the University of Basel. The conclusion concerns an issue felt throughout Switzerland: despite the increase in premiums, the net burden borne by families has remained essentially stable in recent years.

How the burden was calculated

The economists Stefan Felder, Stefan Meyer and Kurt Schmidheiny, from the Basel Center for Health Economics, analyzed information on all Helsana policyholders. The data were cross-referenced in anonymized form with official income information. For the NZZ, the group then prepared an assessment of approximately 300'000 families distributed throughout Switzerland, examining the period from 2016 to 2023 and dividing households into ten income categories.

The result concerns bills net of state subsidies. In all income brackets, the burden remained stable. For a middle-class family, the share of gross income allocated to premiums fell from 6.5% in 2016 to 6.4% in 2023, even though the standard premium, calculated using the lowest deductible and free choice of doctor, increased by 19%.

The NZZ identifies three factors. Many policyholders chose models with limited choice of doctor and higher deductibles, reducing payments. For the median family, gross premiums grew by 11%, i.e. by 750 francs a year. In the meantime, median gross income rose from 88'875 francs to 95'760, an increase of 6885 francs. Federal and cantonal subsidies rose by approximately 440 francs for the median family. More than half of the increase in premiums was therefore absorbed by the Confederation and the cantons.

The analysis also considers families with children, who in 2023 paid on average no more than 8% of gross income. Without state support, for the lowest decile the burden would exceed 20%; with social support, which for many households covers premiums in full, it falls to less than 5%.

Next week, the NZZ recalls, Federal Councillor Elisabeth Baume-Schneider will announce the average premium increase for 2027, expected to be between 4% and 5%.

Operational details

The relationship between premiums and income

The comparison suggested by the analysis is between the gross bill, gross income and the share that remains after subsidies. Looking only at the standard premium can therefore offer a different picture from the one that emerges for the household budget. The median family illustrates this gap well: the price of the standard model increased, but the net burden relative to income remained almost unchanged.

This difference matters especially when comparing different years. An increase in the bill does not automatically produce the same increase in the burden if income or subsidies grow in the meantime. The study also indicates that switching to plans with more limited choice of doctor and higher deductibles reduced payments for many policyholders. This does not mean that every family followed the same path, but it explains why the standard premium alone does not describe actual spending.

For families with children, the 2023 average does not exceed 8% of gross income. The situation of lower incomes is, however, more sensitive to aid: without state support, the burden of the lowest decile would exceed 20%; for many households, social assistance fully covers the premiums and brings the burden below 5%. The result therefore shows a redistributive effect of subsidies, not a uniform reduction in bills.

The region also changes the interpretation. In Ticino, in some regions of Romandy and in Basel, premiums are higher and some families exceed a net burden of 10% of gross income. The national average does not erase these differences. To compare the insurance figure with the household's other expenses, one can consult costo della vita in Svizzera.

Verification for the most recent years remains pending. From 2024 to 2026, the overall progression of premiums was similar to that recorded from 2016 to 2023, while incomes increased only on average. NZZ therefore acknowledges that the burden may have become heavier, but also observes that linking subsidies to reference premiums should have left the state covering a substantial part of the increases. Only future data will show how much the burden has actually grown.

Recommended tools

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

Key points

Five steps for an orderly check

A practical check can be built around the variables considered in the assessment, without turning a national average into an individual forecast. The source does not indicate forms, offices, or deadlines for applying for subsidies: adding a specific procedure would mean introducing information that is not present in the analysis.

1. Separate the gross premium from the support received. Record the total amount and the portion that remains after subsidies, keeping the cassa malati item separate.

2. Set alongside it the household’s annual gross income. This is the reference used in the study to measure the actual burden; comparing the two figures makes it possible to track how the paid share evolves.

3. Identify the insurance model used. The assessment distinguishes the standard premium, with a lower deductible and free choice of doctor, from models with limited choice and higher deductibles. The comparison must therefore refer to the same type of coverage in the years observed.

4. Check federal and cantonal subsidies separately. For families receiving social assistance, it should also be verified how much of the bill is covered, because this component changes the net burden.

5. Note the year and reference area. The comparison between 2016 and 2023 is part of the available assessment; for the period 2024-2026, the picture is still provisional and NZZ refers to data that will become available in the future.

The check must not produce a promise that every family will pay less. It serves to distinguish two questions: how much the bill has increased and how much of the income it absorbs after assistance. The answer may vary with income, the presence of children, the insurance model, and the region, all variables mentioned by the source.

If the personal result appears higher than the national average, this is not automatically a contradiction: the analysis points to regional differences and different income brackets. To relate disposable income to the household budget, complete the check with the calcolatore stipendio.

Source: tio.ch