Health insurance premiums are now the main source of concern for Swiss households. Between cantons that pay double what their neighbours pay, the recurring debate over a single insurer and the persistent question of policyholder accountability, the system is searching for an outcome that neither politics nor the market have yet been able to provide.

In 2026, the average monthly premium in Switzerland stands at 393 francs for basic insurance, a 4.4% increase from the previous year, which itself saw much steeper rises. But this national average masks radically different realities depending on where people live. In Geneva, the country’s most expensive canton, an adult pays an average of 586 francs per month, while a resident of Appenzell Innerrhoden pays only 271 francs for identical coverage. More than double for strictly identical coverage: the observation is stark, but it is not arbitrary. These gaps closely reflect the real healthcare costs in each region, and that is precisely where the full complexity of the problem lies. These disparities are not arbitrary: they directly reflect the real healthcare costs in each region. According to a CSS Institute study, 60% of the differences between cantons are explained by demand for care, in other words by the behaviour of policyholders themselves, and 40% by the density of medical supply. In urban cantons such as Geneva, Basel-Stadt or Ticino, the concentration of doctors, specialists and hospitals mechanically drives up the consumption of care. The proximity of supply creates its own demand, and premiums follow. Added to this is a cultural factor that is often underestimated: insured people in French-speaking Switzerland and Ticino consult doctors more often on average than their German-speaking counterparts, whose tradition of individual responsibility in health matters remains a deeply rooted feature.

It is precisely this observation that periodically rekindles the debate over a single insurer. Its supporters argue that the current system sustains largely fictitious competition: insurers do not compete on the quality of care, which is set by the LAMal, but on selecting good risks and on high administrative costs. According to them, a single public insurer would make it possible to pool these costs and introduce greater transparency in premium setting. Their opponents reply that a monopoly would kill all innovation and all incentives for efficiency, and would turn health insurance into an uncontrollable bureaucratic machine. The Swiss people, consulted four times between 1994 and 2014, rejected this idea each time, the last by 61.5% of the vote. The verdict at the ballot box is clear, even if pressure on household budgets weakens it with every new premium increase. Since the LAMal came into force in 1996, premiums have risen structurally faster than household purchasing power, turning health insurance into a veritable regressive tax for the middle classes.

That leaves the path of accountability, more consensual in principle, more delicate in implementation. The deductible lever already exists: a policyholder who opts for the maximum deductible of 2,500 francs instead of the minimum 300 francs significantly reduces their monthly premium, but bears more of the cost if they fall ill. This mechanism works for healthy people; it penalises people with chronic illnesses, for whom a high deductible quickly becomes a financial trap. Beyond deductibles, what is lacking is genuine health education. Too many policyholders still do not know that calling a family doctor before going to the emergency room can avoid considerable costs that are passed on to all premiums. Too few know that alternative models — network doctors, HMOs, telemedicine — offer discounts of 10 to 20% without reducing the quality of care. Researcher Caroline Chuard-Keller highlights a revealing paradox: most policyholders do not know how their premiums are calculated, nor why they vary so much depending on where they live. Perhaps that is where it all begins, in this space between ignorance and decision, which neither insurers nor public authorities have truly invested in yet. Stabilising healthcare costs will require less a break than an accumulation of coherent reforms: regulating supply, making policyholders accountable, ensuring transparency, maintaining solidarity. A programme modest in its stated ambitions, demanding in its implementation, in the image of Switzerland itself.

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