The Swiss healthcare system
13th January 2015, 0 comments
Swiss healthcare is outstanding. Its combined public, subsidised private and totally private healthcare system create an extensive network of highly qualified doctors (many of them from elsewhere in the EU) and hospitals, the best equipped medical facilities and no waiting lists, but it all comes at a price: around 10 percent of the average Swiss salary goes towards health insurance premiums. There is no free state health service in Switzerland.
Unlike other European countries, the Swiss healthcare system is not tax based or financed by employers but is paid for by the individual through contributions into health insurance schemes. The system is universal but it is administered by individual cantons. This means that everyone living in Switzerland must have basic health and accident insurance (Soziale Krankenversicherung / Assurance maladie / Assicurazione-Mallatie). You pay monthly premiums to the insurer and you also have to pay a contribution towards the cost of medical consultations and treatments. Each family member must be insured individually. Babies are insured from birth but to continue cover, you have to take out health insurance for child within three months of the birth. Children don’t need to be insured by the same company as their parents. As at 2014, an adult pays around CHF 400 in health insurance premiums.
If you are in Switzerland for less than three months, you may be exempted from the requirement for holding basic health insurance if you have an European Health Insurance Card (EHIC), your own health insurance policy, travel insurance or a company healthcare plan – but check with your cantonal authorities to make sure.
After three months everyone has to have organised cover with an authorised Swiss insurer even if you have an international health insurance policy, as these are not usually recognised in Switzerland.
Many people top up the basic cover with supplementary health insurance. Switzerland has one of the largest private healthcare sectors in the world.
Basic health insurance in Switzerland
There are around 80 health insurance companies in Switzerland, each offering the same benefits in the basic health insurance policy and they are obliged to accept anyone who applies, regardless of pre-existing health conditions.
The basic health insurance policy covers:
- Out-patient treatment by officially recognised doctors;
- Emergency treatment;
- A contribution to transport/rescue expenses;
- Medicines prescribed by a doctor and on an official list;
- Maternity check-ups, tests, ante-natal classes, childbirth;
- Abortions and gynaecological check-ups;
- Rehabilitation after operations or illness;
- Medical treatment when on short trips outside of Switzerland;
- Some alternative therapies, like homeopathy and Chinese medicine and psychotherapy if this is given within the medical practice.
The patients’ contribution
In any given year, adults have to pay the first CHF 300 of any medical treatment, apart from maternity services, themselves. This is called an ‘excess’. The insurance will only pay what exceeds the excess and even then, the patient has to pay 10 percent of that amount. This is called the ‘deductible’ and is limited to CHF 700 per year or CHF 350 per year for children. If you need to go to hospital, you have to pay CHF 15 per day.
Health insurance premiums
You are free to choose your own insurer. Monthly premiums may vary from company to company and most charge less for those aged under 25.
You can pay cheaper premiums if you:
- Choose a policy with a restricted choice of doctor or HMO (health maintenance organisation);
- Take out a Telmed policy which requires you to call a telephone counselling service staffed by medical professionals who can refer you to a doctor or hospital;
- Increase your excess from CHF 300 to up to CHF 2500 per year which means that you pay more if you’re ill but have lower premiums when you’re well;
- Have a ‘modest’ income – this is determined by individual cantons and you need to contact your local cantonal authorities for more information.
Supplementary health insurance
You can take out optional supplementary health insurance at an extra cost from the same or separate insurer. Benefits vary from policy to policy but may include orthodontic treatment, spectacles/contact lenses and choice of doctor when you need treatment in hospitals and stays in a private or semi-private ward. The more benefits you get, the higher the premium. Companies can refuse to insure you or refuse or terminate the policy if you give incomplete or inaccurate information.
Look on the Federal Office for Public Health website for a list of insurers and an annually published list of premiums to compare prices.
EU and EEA citizens
European Health Insurance Card (EHIC)
If you already have an EHIC you can get public medical treatment in Switzerland at a reduced cost whilst you are in the country for the first three months. EHIC does not cover private treatment. Keep any paperwork and receipts to apply for refunds or reimbursement on your return to your home country.
Once you take up permanent residence and/or employment you are no longer covered by the EHIC and must register with a Swiss health insurance company.
Going to the doctor in Switzerland
You are usually free to choose your own family doctor (Doktor/ Arzt / Médicin / Medico) unless your insurance policy places a restriction on choice of doctor (see above). In Switzerland, people also choose a paediatrician to look after the health of their children. The doctor can treat you and refer you onto specialists in a polyclinic (out-patient clinic) or hospital. Unless your insurance policy specifies otherwise you may also consult specialists without a referral from your doctor and be covered by your insurance.
You can find a doctor by personal recommendation, through this website or this one, by looking in the health section of the Swiss Yellow Pages where you’ll find doctors, dentists, pharmacists and other health professionals. Your embassy or consulate may be able to recommend a doctor who speaks your native language.
You’ll need to book your appointment beforehand and give 24 hours notice if you need to cancel otherwise you’ll be charged. Take your insurance card when you visit the doctor.
Call your local doctors’ telephone answer service for the contact number of the out-of-hours doctor.
Hospitals in Switzerland
Hospitals are called Krankenhaus / Spital / Hospital / Ospedale – look for a sign with a white ‘H’ on a blue background. Unless it’s an emergency, you have to be referred to a hospital by a doctor. The hospital will usually be in your local canton. You’ll need to take your EHIC or proof of your Swiss health insurance policy. There are three types of wards: general (two to four patients), semi-private (two patients) or private for one patient only. If you have private health insurance you can also choose your own doctor. Basic health insurance covers medical and nursing care and outpatient follow-up although you will be asked to pay CHF 15 per day towards these costs. See Expatica’s list of Hospitals in Switzerland.
After your consultation or treatment, you’ll receive a bill from the doctor or hospital. You need to pay within a specified period of time and then send a copy to your insurance company who will reimburse you the amount covered by your scheme. If you have to go to hospital but don’t have adequate health insurance for your treatment you may be asked to pay a deposit of up to CHF 10,000.
Pharmacies in Switzerland
Pharmacies (Apotheke/Pharmacie/Farmacia), clearly marked with a green cross, are good places to get health advice as well as medicines. The first time you get prescription medicines from a pharmacy you’ll be asked for a small, one-off fee to open a patient file in which the pharmacy will record all your medications. If you go to another pharmacy you’ll have to do the same there so it makes sense to try to go to the same pharmacy each time.
Pharmacy opening hours
Pharmacies are open usual business hours, 08.00 to 12.00 then 14.00 to 18.00 Mondays to Fridays; Saturdays they close earlier around 17.00.
If you need an emergency out-of-hours pharmacy you can find the nearest one to you on this SOS-Pharmacy website (in English). Medicines cost more at out-of-hours pharmacies.
If you’ve been prescribed a branded medicine you’ll be asked to pay a deductible of 20 percent but only 10 percent on generic medicines only, so ask the pharmacist if there’s a generic equivalent. Non-prescription medication is not covered by insurance.
Visiting the dentist in Switzerland
The dentist is called Zahnärzte / Dentiste / Dentista and may work in either private dental practice and public dental clinics. Most dental care is not covered by the basic health insurance and can be extremely expensive in Switzerland. Unless you’re covered by private insurance, it might be worth getting extensive dental treatment on a trip back home.
Adults must pay for their own dental check-ups and treatment although treatment for problems caused by serious, unavoidable, illness is covered by the basic health insurance. Children’s teeth are checked free of charge annually by school dentist but parents must pay to treat dental decay although some local authorities may subsidise the cost. Most people take out complementary insurance to cover dental costs.
Pregnancy and birth in Switzerland
Make your first appointment with your family doctor or gynaecologist. You may also book an appointment with a midwife. You’ll see the doctor or midwife throughout your pregnancy for tests and check-ups. You can give birth in a hospital, birthing centre or at home.
The basic health insurance covers you for seven check-ups, two ultrasounds, allows CHF 100 for ante-natal classes, the cost of childbirth and post-natal care, three breastfeeding sessions and a follow-up exam. You pay nothing towards these costs.
For more information, see the Expatica article Having a baby in Switzerland.
Termination of pregnancy
In Switzerland it’s legal to have an abortion up to 12 weeks after conception without a doctor’s consent; from the 13th week, a doctor must confirm that it is necessary for the woman’s physical or psychological health to terminate the pregnancy. The cost of a termination is covered by the basic health insurance.
In an emergency
Emergency treatment is covered by the basic health insurance and you can consult with any doctor or hospital directly in an emergency, even if you have a restricted choice, HMO or Telmed policy. You may be asked for your health insurance detail even in an emergency so keep them with you at all times.
There are emergency doctors’ services throughout the night and at weekends; call your family doctor for the number.
For urgent medical treatment, go to the A&E or ER (Notaufnahme /d'urgence/pronto soccors) of the nearest hospital; most public hospitals have 24-hour A&E departments.
For an ambulance, call 144, free of charge from any public phone. They will only take the patient to hospital; relatives or friends will have to make their own way. You will have to pay 50 percent of the cost of the ambulance (though no more than CHF 500 per year) so you might want to take the patient to hospital by car or public transport if they are well enough to travel this way.
Other useful numbers, free of charge, from any payphone:
112 – general emergencies.
117 – police.
1818 – information service in German, French, Italian and English.
1414 – Swiss Rescue.
- I need an ambulance! – Ich brauche einen Krankenwagen!
- I need a doctor – Ich brauche einen Arzt.
- Call an ambulance – Appelez une ambulance!
- I need a doctor – J’ai besoin d’un médicin.
- Call an ambulance – Chiamate un'ambulanza!
- I need a doctor – Ho bisogno di un medico.
For more information
Federal Office of Public Health (FOPH), the Swiss national health authority.
Updated from 2012.
Need advice? Post your question on Expatica's free Ask the Expert service to see if we can help.
Bupa Global offers a variety of health insurance packages to expats in more than 190 countries around the world.