Health Insurance as Pawn between Interest Groups

The expansion of the healthcare system also produced a significant rise in healthcare costs in the 1950s and 1960s. In response, the Health and Accident Insurance Act was revised in 1964. The act became the pawn of various interest groups. Reform remained selective; no significant leap was made.

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Reforms in health insurance had lingered and remained complex since the introduction of the Health and Accident Insurance Act of 1911 (KUVG). The number of people with health insurance steadily rose after the Second World War. The share of policyholders in the population increased from 48 percent in 1945 to 89 percent by 1970 – not least thanks to mandatory insurance laws introduced at the cantonal level. The Federal Council and the administration considered the rejection of the tuberculosis bill of 1949 as a veto against compulsory insurance. Hesitant efforts to partially revise the KUVG began in the mid-1950s and were limited to selective reforms that did not call into question the tenets of the almost fifty-year-old policy stalemate.

The 1964 revision that entered into force without facing a referendum made it easier to contract health insurance and increased both benefits and subsidies to existing health funds. Even though it did not contain any substantial reforms, the revision had been preceded by decades of political deadlock. In light of medical progress and the expanding healthcare market, health insurance increasingly became the pawn of well-organized and influential interest groups, especially health funds, doctors and the pharmaceutical industry but also new health professions such as chiropractors. In the case of the 1964 revision, it was primarily medical doctors who were able to negotiate what they considered favorable conditions, such as fee grading according to patient incomes and the conditions of settling fees.

Literatur / Bibliographie / Bibliografia / References: Alber Jens, Bernardi-Schenkluhn Brigitte (1992), Westeuropäische Gesundheitssysteme im Vergleich: Bundesrepublik Deutschland, Schweiz, Frankreich, Italien, Grossbritannien, Frankfurt; Sommer Jürg (1978), Das Ringen um die soziale Sicherheit in der Schweiz. Eine politisch-ökonomische Analyse der Ursprünge, Entwicklungen und Perspektiven sozialer Sicherung im Widerstreit zwischen Gruppeninteressen und volkswirtschaftlicher Tragbarkeit, Diessenhofen.