The objectives of the health system are defined at both the federal and the cantonal level in several laws and policy documents. The Federal Constitution (Art. 41) explicitly states as one social objective of the Confederation and cantons that “every person has access to the health care that they require”. In addition, Art. 117a, which was adopted by popular referendum in 2014 (see section 6.1.4), has added to the constitution the objective of ensuring “the adequate provision of high-quality primary medical care that is accessible to all”.
Cantonal constitutions (e.g. the constitutions of Basel, Bern, Geneva and Zurich) often contain a specific section on health and health care. Although exact provisions differ, these usually state that the canton (and municipalities) will protect and promote health, and will ensure the provision of sufficient and affordable medical care to its population. In addition, specific objectives are often developed by cantons, which may go beyond those stated at the federal level.
The KVG/LAMal – the most important law defining the legal framework of the MHI system (see section 2.1) – was introduced with the aim of achieving three main objectives (FOPH, 2012a): (1) to ensure universal access to high-quality health care; (2) to improve solidarity by reducing the financial burden of insurance premiums on low-income households; and (3) to contain the growth of health care expenditure. These objectives have also remained the guiding principles of most reforms since 2000 (see Chapter 6), which have aimed to improve the functioning of the health insurance system by revising the KVG/LAMal.
Currently, the Health2020 strategy paper approved by the Federal Council in January 2013 summarizes the objectives of the federal government for the health system over the coming years (FDHA, 2013). The document highlights four priority areas for policy action (shown in Box7.1), each including three objectives, which are then further broken down into three specific activities.
Box7.1
The objectives outlined in Health2020 are at the origin of most ongoing and planned health reforms (see section 6.2). One cross-cutting objective of the strategy, reflected in several of the measures summarized in Box7.1, is to contain the growth of health expenditure. In addition, some areas of policy actions have been prioritized and some have already resulted in policy proposals or reforms (e.g. the new KVAG/LSAMal – see section 6.1.3; the planned revision of KVG/LAMal to improve planning in ambulatory care – see section 6.2.2).