医疗保出相同 瑞士医生比加拿大多65% 候诊短得多
尽管瑞士的医疗保健支出与加拿大大致相同，但瑞士的医生数量却比加拿大多出近65%，候诊时间也短得多。
Switzerland has nearly 65% more doctors and much shorter wait times than Canada, despite spending roughly same amount on health care
https://www.fraserinstitute.org/sites/default/files/2025-05/building-responsive-and-adaptive-health-care-systems-in-canada.pdf
Yanick Labrie 2025年5月29日 | 美国东部时间
弗雷泽大学高级研究员
在加拿大构建响应式和适应性医疗保健系统：瑞士的经验教训
尽管公共支出大幅增加，全国患者和医疗服务提供者的不满情绪日益高涨，但加拿大的医疗保健系统越来越无法满足患者的需求，2024年，计划内护理的候诊时间仍达到创纪录的30周以上。
瑞士医疗保健在几乎所有经合组织 (OECD) 绩效指标中均优于加拿大：人均医生和护士数量更多、医疗服务可及性更高、候诊时间更短、未满足需求更低、患者满意度更高（94% 对比加拿大的 56%）。
瑞士通过 44 家相互竞争的私营非营利保险公司确保全民覆盖。公民必须参保，但可以自由选择保险公司，并根据自身需求和偏好定制保险，从而促进医疗可及性和自主性。
瑞士的基本保险覆盖范围比加拿大更广，涵盖门诊护理、心理健康、处方药、家庭护理和长期护理，并设有适度且有上限的费用分摊，以及针对儿童、低收入人群和慢性病患者等弱势群体的豁免。
患者费用分摊（免赔额/共同支付）存在，但该系统包含强大的财务保障：27.5% 的人口获得直接补贴，确保了可负担性和公平性。
风险均衡机制可防止风险选择，并保证保险公司的公平性，从而促进不同人群和健康群体之间的团结。
去中心化治理提高了响应速度；各州负责管理服务规划，确保医疗服务适应当地实际情况和人口需求。
有序竞争推动创新和效率：超过75%的瑞士人现在选择替代模式（例如，健康维护组织 (HMO)、远程医疗和门禁系统）。
瑞士模式证明，一个普遍、多元化且竞争性的体系能够兼顾效率、公平、可及性和患者满意度——这为加拿大停滞不前的医疗改革议程提供了有力的启示。
结论
尽管过去40年来，加拿大人的医疗保健需求显著扩大和发展，但省级单一支付系统在医疗融资和提供方面的基本特征基本保持不变。尽管医疗服务可及性持续下降，且改革呼声不断，但自1984年《加拿大健康法》（CHA）颁布以来，情况并未发生重大变化。
近年来，一些声音谴责CHA的僵化，或提出改革途径，以提高我们省级公共卫生系统的响应能力，使其能够在人口和技术快速变化的背景下满足日益增长的人口需求（Blomqvist，2022；Esmail，2024；Picard，2024）。有意愿和胆量推动此类改革的加拿大政策制定者可以从瑞士医疗保健模式中汲取灵感。
加拿大几乎所有省份都实行相同的医疗保健政策，但在几个关键方面与瑞士的政策有所不同。首先，瑞士民众通过44个相互竞争的私人医疗保险基金获得全民医疗保健，而不是像加拿大那样通过单一支付方公共系统。瑞士联邦立法规定各保险公司的基本医疗保险范围非常广泛，涵盖住院护理、精神健康、处方药和医疗器械、放射学检查以及机构和家庭的长期护理。基本医疗保险的覆盖范围比加拿大的公共医疗体系更为广泛，后者基本上仅涵盖医院提供的医疗必需服务和医生提供的医疗必需服务。此外，瑞士人拥有退出选择权，如果对所获得的服务不完全满意，可以每年两次更换保险公司。这给保险公司带来了压力，并鼓励他们进行创新，以更好地满足人们的偏好并控制保费的增长。
与加拿大人一样，瑞士人在医疗保健方面完全遵循普遍性和公平性的原则（Crivelli 和 Solari，2014）。但与加拿大的情况不同，全民覆盖原则并不一定意味着“首付”保险。事实上，瑞士要求患者通过费用分摊的方式直接参与其所接受医疗服务的部分融资。瑞士的经验表明，此类政策可以鼓励更有效地利用医疗资源，同时抑制不必要的医疗支出。如果与旨在最大程度减少弱势群体财务障碍的措施相结合，则能够
确保医疗服务可及性，且不对民众产生负面影响。瑞士通过限制个人每年自付的最高金额，并免除某些群体（例如儿童、孕妇、低收入人群等）的费用分摊来实现这一目标。
显然，瑞士医疗保险体系的某些组织方式——依赖于多家保险公司和多种保险计划选择——可能违反《加拿大健康法》。《加拿大健康法》要求被保险人遵守“统一条款和条件”，从而不允许保险覆盖的个性化和自主选择。患者参与医疗费用支付也面临同样的情况。《加拿大健康法》明确禁止任何医疗必需护理的共同支付或额外收费。事实上，所有实施这些政策的省份都将面临医疗费用的逐一削减，甚至完全失去联邦医疗转移支付（Esmail，2013）。
我们生活在一个技术日新月异的时代，个性化治疗的能力日益增强，患者的需求也日益增长。这些变化需要适应和创新的能力，而我们的单一支付者公共卫生系统却无法培养这种能力。因此，我们有充分的理由认真探讨改革加拿大医疗保险局（CHA）的可能性，以便允许消费者在相互竞争的保险计划之间进行选择。瑞士的经验为加拿大人引入保险竞争和选择权的潜在益处提供了宝贵的经验。本研究提供的证据表明，精心设计的、在多个保险计划之间进行有管理的竞争体系，可以维护医疗保健服务的普遍性和公平性原则，同时允许组织创新，更好地满足民众的多样化需求和偏好。
Switzerland has nearly 65% more doctors and much shorter wait times than Canada, despite spending roughly same amount on health care
https://www.fraserinstitute.org/sites/default/files/2025-05/building-responsive-and-adaptive-health-care-systems-in-canada.pdf
Building Responsive and Adaptive Health Care Systems in Canada: Lessons from Switzerland
- Canada’s health-care system is increasingly unable to meet patient needs, with wait times reaching record lengths—over 30 weeks for planned care in 2024—despite significantly rising public spending and growing dissatisfaction among patients and providers nationwide.
- Swiss health care outperforms Canada in nearly all OECD performance indicators: more doctors and nurses per capita, better access to care, shorter wait times, lower unmet needs, and higher patient satisfaction (94% vs. Canada’s 56%).
- Switzerland ensures universal coverage through 44 competing private, not-for-profit insurers. Citizens are required to enroll but have the freedom to choose insurers and tailor coverage to their needs and preferences, promoting both access and autonomy.
- Swiss basic insurance coverage is broader than Canada’s, including outpatient care, mental health, prescribed medications, home care, and long-term care—with modest, capped cost-sharing, and exemptions for vulnerable groups, including children, low-income individuals, and the chronically ill.
- Patient cost participation (deductibles/co-payments) exists, but the system includes robust financial protection: 27.5% of the population receives direct subsidies, ensuring affordability and equity.
- Risk equalization mechanisms prevent risk selection and guarantee insurer fairness, promoting solidarity across demographic and health groups.
- Decentralized governance enhances responsiveness; cantons manage service planning, ensuring care adapts to local realities and population needs.
- Managed competition drives innovation and efficiency: over 75% of the Swiss now choose alternative models (e.g., HMOs, telemedicine, gatekeeping).
- The Swiss model proves that a universal, pluralistic, and competitive system can reconcile efficiency, equity, access, and patient satisfaction—offering powerful insights for Canada’s stalled health reform agenda.
Conclusion
While the health-care needs of Canadians have expanded and evolved significantly over the past 40 years, the fundamental features of provincial single-payer systems for financing and delivering health care have remained largely unchanged. Despite a steady decline in access to care and repeated calls for necessary reforms, no significant changes have occurred since the Canada Health Act (CHA) was introduced in 1984.
In recent years, several voices have been raised to denounce the rigidity of the CHA or to propose avenues for reform to make our provincial public health systems more responsive and able to meet the growing needs of the population, in a context of rapid demographic and technological changes (Blomqvist, 2022; Esmail, 2024; Picard, 2024). Canadian policymakers with the desire and audacity to orchestrate such reform could draw inspiration from the Swiss health-care model.
Canada’s health-care policies, common to almost all provinces, differ in several key respects from those adopted in Switzerland. First, the Swiss population obtains universal access to health care through 44 competing private health insurance funds, and not through single-payer public systems like in Canada. The scope of basic health coverage, imposed by Swiss federal legislation on each insurer, is very broad and includes hospital care, mental health, prescribed medications and medical devices, radiological examinations, as well as long-term care in institutions and at home. Basic insurance coverage is more extensive than that in public health-care systems in Canada, which essentially only covers medically necessary health services provided in hospitals and medically required services provided by physicians. Furthermore, the Swiss have exit options and can change their insurer twice a year when they are not fully satisfied with the services received. This puts pressure on insurers and encourages them to innovate to meet people’s preferences better and control the increase in premiums.
Like Canadians, the Swiss fully adhere to the principles of universality and equity in access to health care (Crivelli and Solari, 2014). But unlike Canada’s situation, the principle of universal coverage does not necessarily mean first-dollar insurance coverage. In fact, Switzerland requires patients to participate directly in financing, through cost-sharing, a certain portion of the health services they receive. The Swiss experience suggests that such a policy can encourage more efficient use of health-care resources while curbing unnecessary consumption of care. When combined with measures that minimize financial barriers for the most vulnerable, it ensures access to care without negative impacts on the population. Switzerland achieves this by limiting the maximum amount that one has to spend out of pocket each year and by exempting certain populations from cost-sharing (e.g., children, pregnant women, low-income people, etc.).
Obviously, some aspects of the organization of the Swiss health insurance system— which relies on multiple insurers and insurance plan options—would contravene the Canada Health Act. The CHA disallows the personalization and choice in insurance coverage by requiring “uniform terms and conditions” for insured persons. The same is true for patient participation in the costs of care. The CHA explicitly prohibits any co-payment or extra-billing for medically necessary care. In fact, all provinces implementing these policies would face dollar-for-dollar reductions or a complete loss of federal transfers for health care (Esmail, 2013).
We live in an era of rapid technological change, with an increasing capacity to personalize treatments and increasing patient demands. These changes require a power of adaptation and innovation that our single-payer public health systems do not foster. These are good reasons to engage in a serious debate on the possibility of reforming the CHA in such a way as to allow consumers to choose between competing insurance plans. Switzerland offers valuable lessons on the potential benefits of introducing insurance competition and choice for Canadians. Evidence presented in this study shows that a carefully designed system of managed competition between multiple insurance plans can preserve the principles of universality and equity in access to health care while allowing for organizational innovations that better meet the diverse needs and preferences of the population.
Introduction
In recent years, several analysts have highlighted the inability of provincial health systems to respond adequately and in a timely manner to the needs of their population and pointed out the many structural barriers to the necessary changes, notably created by the Canada Health Act (CHA) (Boychuk, 2012; Clemens and Esmail, 2012; Esmail and Barua, 2018; Parsons Leigh et al., 2024). Indeed, the numerous failures of provincial health systems, in particular their inability to deliver the required medical care in a timely manner, are well documented. In 2024, half of Canadians waiting for a planned medical treatment had to wait more than 30 weeks after a referral from a general practitioner—the longest delay in 30 years (Moir and Barua, 2024a). As in many countries, the COVID-19 pandemic has exacerbated the difficulties of accessing care for Canadians (Labrie, 2023). But even before the pandemic, long wait times for medically required care had already become a structural feature of Canada’s health-care systems.
This deterioration in access has occurred even though public funds devoted to health care have continued to increase massively over the past two decades. Taking into account inflation, per capita public health-care spending in the country has increased by twothirds since the start of the millennium, rising from $5,300 in 2000 to $8,800 in 2023 (CIHI, 2024a).1 Despite the considerable injection of taxpayers’ money into our public health-care systems, Canada is unable to close the gap that separates it from other countries in terms of wait times and availability of medical resources (CIHI, 2024b; Moir and Barua, 2024b). Canada has proportionally fewer doctors and health-care workers than the vast majority of peer countries (Moir and Barua, 2024b). This poor relative performance of Canadian health systems translates into productivity losses that affect patients directly and the rest of the economy indirectly (Moir and Barua, 2024c).
Maintaining the status quo in health care is untenable and more and more Canadians are expressing their desire for change. In a recent survey of some 5,000 respondents, more than four in five Canadians said they believe their health-care system is in crisis or requires significant change. Only 18% said that their health care system “works well,” the lowest percentage in the last 35 years (Jacques and Perrot, 2024). Other recent surveys have also revealed that a high and growing percentage of patients in Canada are dissatisfied with how their provincial government is handling health care, and would like to have more care options from the private sector (Angus Reid Institute, 2024; Ipsos, 2024).
Given the increasing dissatisfaction with Canada’s health-care systems and the growing interest in alternative models, it is worthwhile to examine how other countries have successfully addressed similar challenges. This study focuses on the changes implemented in one of these countries, Switzerland, over the last 30 years. Switzerland’s universal, consumer-driven health-care system is often praised for its effectiveness and equitable performance (Biller-Andorno and Zeltner, 2015; Björnberg and Phang 2019; Carroll and Frakt, 2017; De Pietro et al., 2015; Rathi and Girvan, 2024). It has also been identified as highly responsive to patients’ needs and preferences, and one in which wait times are not considered to be a problem (Esmail, 2013; Cylus and Papanicolas, 2015; Siciliani et al., 2023).
The Performance of the Swiss Health System
Before describing the structural characteristics that distinguish the health systems in Switzerland and Canada, it is important to look at their respective overall performance. To do this, we refer to comparative data compiled by the Organisation for Economic Co-operation and Development (OECD) (OECD, 2023a) following the methodological approach used by Moir and Barua (2024b), and divide performance indicators into four broad categories: [1] availability of resources; [2]
use of resources; [3] access to resources; and [4] quality and clinical performance. We add to these indicators those pertaining to the health status (life expectancy at birth, preventable and treatable mortality, etc.) and the satisfaction of the population regarding the health-care system. On this subject, rankings have been produced on a global scale and it is useful to refer to them to refine the comparison of the two health systems.
Availability of resources
To carry out our comparison in terms of resource availability, it is important to first look at the level of expenditure devoted to health care in the two countries. In 2022, Switzerland spent 11.9% of its GDP on health care, compared to 11.5% for Canada, after adjusting for differences in the age structure of the population. When we look at health expenditure per capita, Switzerland is ahead of Canada and all OECD countries, with expenditure per person amounting to US$9,218 (adjusted for purchasing power parity [PPP]). Canada comes 9th inthis international ranking with health expenditure totalling US$7,035 per person (PPP-adjusted) in 2022 (Moir and Barua, 2024b).
Switzerland, however, gets more value for its money in terms of availability of professional and medical resources, with almost 75% more doctors and nurses than Canada as a percentage of population. With 2.8 doctors per thousand inhabitants, Canada ranks 36th among the 38 OECD countries in this regard. Switzerland, for its part, ranks among the best performing countries, with 4.6 doctors per 1,000 inhabitants in 2022 (8th place). When it comes to the number of nurses, Switzerland is ahead of all OECD countries, with 18.8 per thousand inhabitants. Canada is in the middle of the pack compared to its international peers, with 10.5 nurses per 1,000 population.
Switzerland also surpasses Canada in the number of curative hospital beds and in the number of units of medical imaging equipment (MRI units, PET scannners, CT scanners) (table 1). With 4.4 beds per 1,000 inhabitants, Switzerland ranks 17th in the OECD in 2021, just above the average. Canada ranks 36th out of a total of 38 countries, with 2.6 beds per thousand population. Regarding the combined number of units of medical imaging equipment, Switzerland ranks 8th, while Canada ranks 37th,with two and a half times fewer units in proportion to its population.
Switzerland outperforms Canada in the percentage of its population that reports having a regular doctor or a place to obtain primary care, and in the rate of satisfaction with the availability of health services. In 2022, 94% of Swiss said they were satisfied with the availability of quality health services in the region where they live, the highest percentage among OECD countries, while only 56% of Canadians reported being satisfied, which places Canada at the 30thspotin the ranking (OECD, 2023a).
Use of resources
Table 2 compares Canada and Switzerland based on eight indicators of activity in their respective health systems. The comparative portrait shows that Switzerland outperforms Canada in five of these eight indicators in 2022: the rate of hospital discharges (higher), emergency department visits (lower), medical imaging examinations (higher), and hip and knee replacement surgeries (higher). Switzerland ranks first among OECD countries for the number of hip and knee replacements per 100,000 inhabitants, while Canada ranks 23rd and 11th respectively in these areas of surgery. On the other hand, Canada surpasses its counterpart in terms of number of medical consultations per capita, as well as coronary artery bypass and cataract surgeries per 100,000 people.
Access to resources
Unlike the situation in Canada, waiting times in Switzerland are not considered a priority among public policy issues (Siciliani et al., 2023). Switzerland does not collect systematic data on waiting times, given that there is no difficulty accessing health care in this country. It is therefore necessary to refer to sample survey data from the population.2
Hence, despite a lower level of public spending compared to Canada (Lafortune and Mueller, 2020), Switzerland shows better results in terms of accessibility to primary care (Senn et al., 2019). Survey data from the Commonwealth Fund (CWF) reveals that 76% of the Swiss population reported being able to obtain a medical appointment with a doctor or a nurse within 5 days, while only 46% of Canadians said they have been able to do so (CIHI, 2024b). Not only is access to primary health care faster in Switzerland than in Canada, but there is no inequality of access according to the level of education or income in the Swiss health-care system. In contrast, several groups of researchers have found that low-income Canadians report longer waiting times to get an appointment with their primary care physician (Martin et al. 2020; CIHI, 2024c).
Switzerland’s performance is also among the best of all OECD countries in terms of speed of obtaining a consultation with a specialist doctor and being operated on for a planned procedure. As shown in figure 1, 85% of Swiss people surveyed by the CWF reported being able to obtain a consultation with a specialist within two months. In comparison, only 48% of Canadians admitted they could get an appointment as fast (CIHI, 2024b).
As for the waiting time to obtain an elective surgery, Switzerland displays results among the best of the countries compared by the CWF. In fact, 72% of Swiss admitted to being able to have a planned surgery in less than two months. By way of comparison, less than 40% of Canadians surveyed reported obtaining their elective surgery within such time frames (CIHI, 2024b). Survey data also show notable differences in this regard within Canadian provinces, while elective surgeries could be obtained in less than two months by a little more than half of Ontarians and only 22% of British Colombians (figure 2).
Quality and clinical performance
For several years, the OECD has been compiling a series of clinical performance indicators which it publishes periodically in its flagship publication Health at a Glance. The comparison covers several dimensions of quality, measuring for example the effectiveness of primary care, the effectiveness of acute care, the prevention and treatment of cancer, as well as the safety of patient care. Table 3 on page 10 shows the most recent comparative results for the 19 clinical performance indicators for which data for Switzerland and Canada exist in the OECD database. Switzerland’s performance surpasses that of Canada in 15 of these indicators.
One of the most revealing indicators of quality of care in the Swiss health-care system concerns preventable and treatable mortality rates, which cover causes of death that can be prevented and treated by effective and timely health-care interventions. Switzerland ranks at the top of all 38 OECD countries in this regard, which says a lot about the efficiency of its health-care system. Thus, the risk that a patient suffering from an illness for which effective treatments exist dies—due to not having received appropriate care in the required time—is lower in Switzerland than in any other OECD country.
Unsurprisingly, the good overall performance of the Swiss health-care system translates into better health outcomes for the population. Thus, Switzerland comes second in the world in terms of the longevity of its population, with a life expectancy at birth of 83.9 years, being slightly behind Japan.3 In comparison, Canada ranks 17th, with a life expectancy at birth of 81.6 years (OECD, 2023a). Switzerland is in fact the only country to rank above the average of the 38 OECD countries for all four measures of health status (life expectancy, avoidable mortality, prevalence of chronic conditions, and self-rated health).
These gains in life expectancy would have little value if they had been accompanied over time by health problems undermining the quality of life of citizens. However, longitudinal data covering a full decade (2007–2017) confirm that gains in healthy or disabilityfree life expectancy have been greater than overall life expectancy gains obtained in recent years, leading to a decline in morbidity during this interval in Switzerland (SeematterBagnoud et al., 2023).
Finally, other academic studies confirm Switzerland’s strong relative performance in international health-care rankings. In 2020, a group of researchers compared the effectiveness of health insurance systems in meeting the health-care needs of the population in 204 countries. Using 23 indicators, they developed the Universal Health Coverage effective insurance index, which measures how well health-care systems across the world translate insurance coverage into actual health gains. Switzerland came in 4th place in the world, just behind Japan, Iceland, and Norway. Canada ranked 11th,tied with five other countries (Lauzano et al., 2020).
More recently, as part of the Global Burden of Disease project, an international team of researchers established the Healthcare Access and Quality Index, which allowed them to assess and rank these same 204 countries based on access to care, quality of care, and the incidence of 32 causes of preventable mortality. Over a period of almost 30 years (1990–2019), Switzerland ranked second in the world, trailing only Iceland (Haakenstad et al., 2022).
The Organization and Financing of the Swiss Health System
The Swiss health-care system is universal and organized according to principles of regulated competition (Enthoven, 1993). Its governance structure is also highly decentralized. Switzerland’s 26 cantons4 independently oversee workforce planning, provider licensing, and system coordination and monitoring, while regulatory authority rests with the federal government. The decentralized nature of the health system has the advantage of adapting the provision of care to the heterogeneous preferences and needs of the population (Crivelli and Salari, 2014).5
The universality of the health-care system was achieved in 1996 with the adoption of the Federal Health Insurance Act (KVG/LAMal), which mandated all Swiss residents to take out health insurance with the private insurance company of their choice.6 The reform aimed not only to ensure the universality of medical coverage, but also to fill the existing gaps in the package of benefits covered, control the health spending growth, and improve the responsiveness of the system by strengthening competition between private health insurance funds (Crivelli, 2020).
Since then, basic health insurance has been compulsory, but consumers can freely choose their insurer among the 44 private companies operating in the market (as of 2023) (Federal Office of Public Health [FOPH], 2025).7 If someone fails to enroll, the canton assigns them to an insurer. By law, insurers must accept all applicants and cannot terminate coverage, even for unpaid premiums. They are also required to maintain coverage for delinquent customers, while health-care providers must provide at least emergency care regardless of payment status.8 However, individuals with outstanding premium debts are prevented from switching insurers (Schmid et al., 2022).9
The scope of basic health coverage, imposed by federal legislation on each insurer, is very broad and includes hospital care, mental health, prescribed medications and medical devices, radiological exams and diagnostic tests, as well as long-term care in institutions and at home (van Kleef et al., 2024). Basic insurance coverage is more extensive than that in effect in provincial health-care systems in Canada, which essentially only cover medically required health services provided in hospitals and doctors’ offices (see table 4 for the distinctive characteristics of the health-care systems in the two countries).
Private insurers in Switzerland cannot extend the breadth of coverage of basic health insurance, but they are allowed to sell supplementary health insurance plans, which cover some benefits not included in the basket of the basic plan (e.g., dental services) (Schmid et al., 2022). In the basic health insurance scheme, insurers compete to attract customers by offering different tailored insurance plans, which have varying deductibles and premiums, as well as managed care arrangements (e.g., restricting choice of providers for lower premiums) (as described in more details in table 5).
The standard health insurance plan includes free choice of family doctor, an individual deductible of 300 Swiss francs (CHF) (CA$470) and a co-insurance rate of 10% up to a maximum annual amount of CHF 700 (CA$1,095) for adults. An insured person who has opted for a deductible of CHF 300 (CA$470) will therefore pay a maximum of CHF 1,000 (CA$1,565) out-of-pocket for insured health services per calendar year. Children aged 18 and under are not required to pay a deductible and the co-insurance limit is set at CHF 350 (CA$550) annually.10 Consumers can choose a higher deductible, which ranges from CHF 500 (CA$780) to CHF 2,500 (CA$3,915), and opt for health plans with managed care features, in exchange for a lower insurance premium.
The primary objective of deductibles and co-insurance is to make patients aware of the costs of their treatments and to reduce the incentive to overconsume health-care services, in the context where they are financed collectively (what economists call moral hazard) (Barua and Moir, 2022). Swiss data also show that healthier people are more likely to opt for a high deductible and limit doctor visits and excess health-care spending by being more price sensitive (Gerfin et al., 2015). These tools therefore encourage policyholders to adopt preventive behaviour and avoid unnecessary doctor or emergency room visits for minor conditions that do not require it, as confirmed by numerous studies (Boes and Gerfin, 2016; Courbage and Nicolas, 2021; Gerfin et al., 2015; Salvi et al., 2023; Trottmann et al., 2012).
Despite the widespread reliance on user charges in different areas of health care in Switzerland, the financial protection for low-income individuals is strong. In fact, the mechanisms put in place that limit the financial participation of certain groups of people to protect them against excessive health spending are among the most robust in Europe (Thomson et al., 2024). Switzerland is one of the countries with the lowest financial barriers to accessing health care (Kim et al., 2017). In 2021, during the first year of COVID-19, 5.8% of Swiss residents interviewed as part of the International Social Survey Programme (ISSP) reported having had to forgo seeking health care because they could not afford it (ISSP Research Group, 2024). According to the 2022 survey of Statistics on Income and Living Conditions (SILC), only 0.5% of the Swiss population (and 1.3% of the poorest income quintile) reported having an unmet need for medical care because it was too expensive (Eurostat, 2023). Taken together, these figures suggest that “financial protection of Swiss households from the costs of medical care is good (and better than in many European countries)” (De Pietro et al., 2015: 238).
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