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06 February 2026 | Policy Analysis
The EFAS reform introduces uniform financing of outpatient and inpatient services -
17 September 2024 | Country Update
Removing mandatory physician prescriptions for selected nursing services -
24 May 2017 | Country Update
Swiss Parliament plans to extend contract duration in mandatory health insurance to prevent strategic deductible optimization
6.2. Future developments
The federal government’s Health2020 strategy paper outlines the reform priorities for the coming years (FDHA, 2013). It defines four priority areas for policy action (see section 7.1): (1) quality of life; (2) equality of opportunity; (3) quality of health care provision; and (4) transparency. Reform activities are ongoing in each of the four priority areas, which can not all be summarized here. However, three particularly important areas, which form part of these activities are: (1) improving the use of information; (2) improving planning of ambulatory care; and (3) improving health care provision for people with specific needs. Given the lengthy process of making health reforms, most of these areas have already been on the political agenda for quite some time. However, it will still take several more years before activities will ultimately lead to institutional or legislative changes.
Across all reforms, there is discussion about the future roles of the cantons and the federal government in health policy development. A consensus seems to be emerging that a greater role for the federal level, at least in the coordination of activities, is necessary. Therefore, although none of the current reform proposals would alter the distribution of competences, they all confirm the trend towards greater influence for the federal government in the health system.
A fragmented funding regime created misalignment of incentives
In December 2023, a major amendment to the Federal Health Insurance Law (KVG/LAMal) for the uniform financing of outpatient and inpatient services, short EFAS (Einheitliche Finanzierung der Ambulanten und Stationären Leistungen), was adopted by Parliament to address the fragmented financing system of outpatient and inpatient care. Since the introduction of the revised hospital financing model in 2012, inpatient services were dual financed (with at least 55% paid by cantons and up to 45% by insurers), while outpatient services were funded almost entirely through insurance premiums.
This sector-specific allocation of funding has long been identified as a structural weakness, contributing to rising costs and inefficient care pathways through inadequate incentive structures. Providers, insurers, and cantonal authorities were encouraged to favour care settings based on fiscal responsibility rather than clinical appropriateness. Cantons had an incentive to promote outpatient care, for which they bore no direct costs, while insurers, covering the full cost of outpatient services, had weaker incentives to encourage cost-saving substitutions from inpatient to ambulatory care. Over time, this misalignment was seen as incompatible with broader goals of integrated care, efficiency, and treatment decisions guided by medical need.
A single allocation key for all services regardless of care setting
EFAS introduces a single allocation key across care settings, reducing distortions created by the previous sector-specific financing model. By aligning financial responsibilities, the reform supports the “ambulatory before inpatient” principle on clinical rather than financial grounds and improves allocative efficiency. It also rebalances the sharing of rising health care costs between premiums payers and cantons. Under EFAS, cantons will make a uniform contribution equal to 26.9% of net costs (after patient cost-sharing) for all services covered by mandatory health insurance (MHI), regardless of setting. The remaining 73.1% will be financed through MHI premiums. This allocation key is established in federal law but may be amended through future legislation. The reform applies to all inpatient and outpatient services, including the long-term care sector (nursing homes and home care).
The reform was approved by popular vote in November 2024, providing strong democratic legitimacy, and is implemented in two phases: As of 1 January 2028, the uniform EFAS financing model will apply to both outpatient and inpatient services covered by MHI, allowing time for technical adjustments and coordination between cantons and insurers. As of 1 January 2032, long-term care services will follow, allowing extra time in light of complexity and interaction with other financing regimes.
Key challenges identified in ex ante assessments include managing the fiscal impact on cantonal budgets, ensuring transparency in cost accounting, and coordinating implementation across federal and cantonal levels. Future evaluations will be critical to assess whether EFAS delivers on its promise to curb cost growth while improving the coherence of service delivery.
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All Swiss residents have the opportunity to change their Mandatory Health Inusrance (MHI) provider, health plan and deductible level at the end of each year.
Higher deductible levels relate to a premium rebate of maximum 50% of the premium with the lowest deductible level. Accordingly, for a healthy individual, the cost-minimizing insurance contract is the highest deductible level. However, when a person plans an expensive intervention for the next year, it is possible to reduce the future financial burden by lowering the deductible level at the end of the prior year.
Current plans of the Swiss parliament aim to hinder such strategic deductible hopping by extending the duration of the deductible contract from one year to three years. A possible amendment of the present law is currently under discussion. However, in order to pass, both councils of parliament will have to accept the amendment, which is unlikely to happen before the end of 2018.
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References
Neue Zürcher Zeitung. 18.4.2017. Kampf gegen Franchisen-Optimierer. [Fight against deductible optimizers] https://www.nzz.ch/schweiz/krankenkassen-kampf-gegen-franchisen-optimierer-ld.1287321, last accessed: 1 May 2017
6.2.1. Improving the use of information: HTA, quality improvement and e-health
There are two important fields in which legislative activity is currently ongoing: one is the area of quality improvement and HTA, where a draft Federal Law on the Centre for Quality in MHI was recently abandoned in favour of the idea of a Network for Quality in Health Care. The other is the area of e-health, where a proposed EPDG/LDElP was adopted by Parliament on 15 June 2015.
In fact, improving quality management and HTA has already been on the political agenda for quite some time. In 2009, the FOPH published a National Quality Strategy for the Health System (FOPH, 2009) and measures to implement the strategy were proposed in 2011 (FOPH, 2011b). In the area of HTA, two associations have been founded since 2008 (the Swiss Medical Board and SwissHTA), which aim to promote the use of HTA for decision-making on health care coverage (see section 2.7.1), and consensus seems to be emerging that a stronger process for systematic HTA is needed. A draft Federal Law on the Centre for Quality in MHI was proposed in 2014 with the aim of creating a national centre for quality as a public institution under the Federal Council (Federal Council, 2014). This new structure would have strengthened activities of the federal government in the areas of quality management, patient safety and HTA.
However, during a preliminary parliamentary consultation process, it became evident that considerable opposition existed against the creation of a new institute. In particular, concerns were raised by many actors concerning the relationship between the new institute and existing structures, such as the ANQ, the Foundation Patient Safety Switzerland and the Swiss Medical Board. Opposition was strongest at the level of the corporatist actors, such as MHI companies, hospitals, physicians and the existing institutions. Together, these actors lobbied for strengthening existing multi-stakeholder structures instead of creating a new institute under the Federal Council. As a result, the Federal Council is now proposing to set up a Network for Quality in Health Care and the FOPH is currently drafting a new proposal for an amendment to KVG/LAMal (FOPH, 2015a). The idea is to strengthen existing institutions, programmes and projects by securing sufficient financial resources for quality management, patient safety and HTA.
The recently adopted EPDG/LDElP is only one of many initiatives of the Federal Council that aim to promote the use of e-health in the health system. A national e-health strategy was published as early as 2007 and eHealth Suisse, a joint coordination body of the Confederation and the cantons, was created in 2011 to coordinate the development of e-health initiatives in Switzerland and to implement the federal strategy (see section 4.1.4). There have been substantial delays in the implementation of the strategy; notably in the development of electronic health records because of legal uncertainties. The EPDG/LDElP aims to provide the required legal certainty. The general idea of the law is that patients remain in control of their data as they can decide if they want their data to be integrated into a virtual electronic health record and can define which providers are to be allowed access to their data. For ambulatory providers the use of electronic health records would be voluntary, but hospitals would have to integrate relevant data into electronic health records. The proposed law was approved by the Council of States in June 2014. However, the other chamber of parliament (the National Council) subsequently passed a stronger version of the law, which meant that it required a re-examination by the Council of States before being passed in June 2015.
In addition, there are a host of cantonal activities in the area of e-health with the most advanced (pilot) projects existing in Aargau, Basel-Stadt, Fribourg, Geneva, Luzern, St Gallen, Ticino, Valais, Vaud and Zurich.
6.2.2. Improving planning of ambulatory care
In February 2015, the Federal Council proposed a revision of KVG/LAMal with the aim of improving planning of ambulatory care. Despite the size of the ambulatory care sector in Switzerland, which accounts for more than 30% of THE (only slightly less than hospital inpatient care; see section 3.2), there has been no mechanism for systematic planning of ambulatory care (see section 2.5). The only measure available to cantons for influencing ambulatory care provision has been a temporary ban on new ambulatory facilities, which was originally introduced in 2001. The ban was continually renewed until the end of 2011 and allowed cantons to withhold MHI charging licences if there was no need for additional providers in the canton (Bolgiani, 2009). In July 2013, the ban was again renewed for three years until mid-2016.
The draft law has proposed replacing the temporary ban with a more comprehensive solution for ambulatory care planning. The overall aim is to ensure wide availability of primary care providers, while preventing an uncontrolled increase of specialist providers. If the law is enacted, cantons will be able to take measures against both an oversupply and undersupply of ambulatory care providers. They will be able to withhold MHI charging licences for new physicians (e.g. in certain specialties), chiropractors and hospital outpatient departments, and they may provide financial incentives (e.g. free infrastructure) for providers in underserved areas.
Cantons will not be obliged to plan ambulatory care provision. However, if they wish to undertake measures against over- or undersupply, the law defines two prerequisites. First, they will have to assess the ambulatory care needs of their populations. The Federal Council will define the criteria and methods for the assessment, and cantons will coordinate their assessment with neighbouring cantons. Second, cantons will have to convene a commission of insured, insurers and providers, which will be asked to comment on ambulatory care provision in the canton and to make recommendations on measures against over- or undersupply. Cantons will have to take these recommendations into account and will have to justify their actions if they decide to implement different measures.
The intention of the Federal Council is that the draft law will replace the temporary ban in mid-2016. However, the responsible parliamentary committee has disagreed with the proposition and it is uncertain if the reform will pass. If the reform is not passed by mid-2016, it is possible that the temporary regulation will be extended or made permanent.
6.2.3. Improving health care provision and prevention for people with specific needs
Improving health care provision for people with specific needs is an area in which reforms are likely to be developed over the coming years. In response to the rejection of the managed care reform in 2012, the Federal Council is currently exploring new measures for improving coordination and quality of care for those patients with the highest health care needs (FOPH, 2014c). The 2015 National Health2020 Conference was dedicated to the topic of improving coordination of care. In addition, national plans for specific health conditions have already been developed over the past few years, usually originated by the National Dialogue on Health Policy (see section 2.3). The National Dementia Strategy 2014–2017, the National Strategy for Palliative Care 2010–2012 (prolonged for 2013–2015), and the National Cancer Strategy 2014–2017 are the three most important ones. A draft for a national strategy for the Prevention of NCDs was presented in August 2015.
All these strategies pave the way for further developments, both at the federal and the cantonal level (changes in the university programmes, new programmes of continuous education, etc.), and often they are linked to current reform proposals. A major example referring to the National Strategy against Cancer is the Federal Council’s proposal for a Federal Law on the Registration of Cancer, which was sent to Parliament at the end of 2014. The draft law proposes harmonizing the registration of cancer cases across Switzerland and integrating information from cantonal cancer registries (which would continue to operate) into a national registry.