National health insurance premium: the League's proposal

Context

In brief

• The League proposes an equal prize throughout Switzerland
• Initiative presented on 1 October in the Grand Council
• Same conditions for age, deductible and insurance model
• Objective: to amend the KVG and, if necessary, the Constitution

Key Facts

• Who → group of the Lega dei Ticinese
• Where → Bellinzona, Grand Council
• Date → October 1
• Premium → the same for the same age, deductible and insurance model
• Basis for calculating → total costs of AOMS services in Switzerland

On 1 October, in Bellinzona, the Lega dei Ticinese group presented a cantonal initiative to the Grand Council to introduce a national health insurance premium. The request is precise: with the same age, deductible and insurance model, the premium should be the same throughout Switzerland, regardless of the canton of residence and the economic situation of the insured.

The text aims to amend the KVG and, if necessary, the Federal Constitution. The proposal would replace the current territorial differentiation with a system in which the costs of compulsory health insurance, referred to as AOMS, are taken into account on a national scale.

Alessandro Mazzoleni appears as presenter. The act is co-signed by Stefano Quadri, Sem Genini, Raffaella Zucchetti, Omar Balli, Maruska Ortelli, Mauro Minotti, Andrea Sanvido, Andrea Censi and Daniele Piccaluga, all for the Lega group.

The principle of national solidarity

The political principle of the initiative starts from a passage: mandatory benefits are defined by federal law and, according to the promoters, financial solidarity should therefore also have a national dimension. Today, the text notes, premiums are affected by the differences in cost between cantons and the place of residence of the insured.

With the proposed model, territorial differences in health needs, supply and risk structure would be compensated at the Swiss level. They would no longer be passed on in full to the premiums of the population of the canton concerned. The text defines this solidarity above all territorial.

The national premium would not become an income-related levy. It would remain nominal: income and assets would continue to be taken into account for individual reductions for people and households in modest economic circumstances. The deductible, the deductible and other cost-sharing instruments would remain separate from the premium.

To follow the topic and distinguish premium, deductible and cost sharing, the cassa malati page is available. The central point is therefore the transition from a premium also conditioned by the territory to a premium determined according to a national logic, keeping the cost sharing tools and reductions linked to economic conditions distinct.

Operational details

The proposal shifts the point of view from the canton to the whole country. For the insured, the practical consequence described in the text is that the domicile would no longer determine a territorial difference in the premium, while the conditions related to age, deductible and insurance model would remain the same. The proposed solidarity would not be calculated on income: the premium would remain nominal, while income and wealth would continue to be included in the individual reductions for people and households in modest economic conditions.

The territorial effect emerges above all for peripheral regions. The initiative notes that being able to use facilities outside the canton does not mean doing so under the same conditions. The example given is the comparison between an inhabitant of Zug, who can reach the centres of Zurich more easily, and a resident of Ticino, who has to go to centres in central Switzerland. Distances and travel times weigh heavily when treatment is repeated, in the presence of chronic diseases, with advanced age or when accompaniment is needed.

According to the initiators, these elements alone do not explain the entire difference in costs or premiums between cantons. However, they should be included in the planning and financing of healthcare services, so that the burden of ensuring affordable care in peripheral regions does not fall solely on those who live there. To follow the topic in the context of daily expenses, the costo della vita in Svizzera guide is also available.

Rebalancing without reducing care

A uniform premium would require compensation between insurers and, if necessary, between territories. The aim would be to prevent a particular risk structure or the concentration of costly cases from producing imbalances that are incompatible with the single premium. Insurers would have to cover the AOMS benefits with national premium revenues, risk compensation and other statutory flows, while respecting reserves and solvency.

If significant or persistent deviations from the expected balance emerge, the fund should justify them to the supervisory authority and submit a repayment or adjustment plan. The Confederation should check whether the cause is managerial, administrative, contractual, linked to risks that have not been adequately compensated or exceptional. The national premium could be reviewed if the actual costs diverge systemically.

Cost containment, however, could not reduce compulsory services, encourage risk selection or create barriers to access to care.

Recommended tools

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

Key points

To transform the text of the initiative into an operational reading, it is advisable to follow five steps. The sequence lines up the parameters, controls and guarantees indicated in the proposal, without attributing to the model an effect different from that described.

1. Determine the parameters for comparison. Age, deductible and insurance model must remain the same. The draft links premium equality to these conditions and decouples it from the canton of residence and the economic situation.

2. Separate the items of expenditure. National premium, deductible, percentage rate and other cost-sharing instruments have distinct roles. The analysis of a possible change must therefore avoid automatically adding elements that the proposal keeps separate.

3. Check the individual reduction. The premium would remain nominal, but income and assets would continue to be taken into account for reductions for people and households in modest economic circumstances. This is the step to be observed when the economic situation affects the cost incurred.

4. Measure territorial accessibility. For repeated care, chronic diseases, advanced age or the need for accompaniment, distances and travel times must be considered. The proposal calls for these elements to be included in the planning and financing of the health offer.

5. Follow the annual cycle and data. In the model, the competent federal authority would determine the premium each year on the basis of the total costs of the compulsory health insurance in Switzerland, forecasts and solvency requirements. Insurers would submit costs, administrative costs, revenues, reserves and risk compensation data in a uniform manner; method, assumptions and corrections should be public and transparent.

Checking after the award has been determined

The last check concerns deviations. If the envisaged financial equilibrium is significantly or persistently in question, the insurer would have to provide the supervisory authority with a documented justification and a plan for repayment or adjustment. The Confederation would have binding tools at its disposal to distinguish between management inefficiencies, administrative costs, contractual conditions, uncompensated risks and exceptional events. Depending on the cause, corrective measures could be imposed, the risk compensation could be changed or the national premium could be reviewed.

To complete the personal budget analysis, use the calcolatore stipendio.

Source: tio.ch