The Failed Emergency Programme for Health Insurance

Following the failed health insurance reform of 1974, the Federal Council and Parliament made another attempt in the 1980s to curb rising health costs. However, the partial revision of the Health Insurance Act was rejected decisively in a referendum in 1987.

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Since the 1960s, efforts to revise the Health Insurance Act (KVG) have faced steep hurdles. Benefits provided by health insurance schemes were considered insufficient by leftwing and centrist parties. On the other hand, bourgeois forces criticized the unfettered rise in healthcare costs. Soon, everyone was talking about a ‘cost explosion’.

Following the failure of the 1974 reform, federal authorities felt compelled to act. In 1977, the Confederation froze the level of subsidies in response to rising costs. At the same time, the Federal Council and Parliament put forward an ‘emergency programme’ to counteract increasing costs and deficits. The programme was limited to a partial revision of the Health Insurance Act and ruled out fundamental reforms such as the introduction of mandatory insurance, new financing sources or substantial improvements to benefits. Another failure was to be avoided at all costs.

In 1987, Parliament passed a revised KVG. On the one hand, the reform envisaged an increase in policyholders’ deductibles. They were to pay an annual deductible as well as a retention fee (20 percent of health costs). On the other hand, rising costs were to be addressed by monitoring treatments as well as requirements regarding doctors’ tariffs and federal subsidies. The proposal also contained a moderate expansion in benefits. The full costs of hospital stays were to be assumed by health insurance, and an expansion in home care was planned. However, the proposal did not include the introduction of a mandatory insurance to compensate income loss during sick-days.

A secondary aspect of the 1987 proposal presented another stumbling block. The authorities combined the partial revision of the Health Insurance Act with an amendment to the income compensation scheme in an attempt to finally implement the existing constitutional principle for maternity insurance. The proposal granted women a maternity daily allowance for a period of 16 weeks. The costs were to be financed by payroll contributions, split equally between employers and employees. Business and small employers associations rejected this maternity insurance and challenged the proposal through a referendum.

On 6th December 1987, a clear majority of 71.3 percent of voters turned down the partial revision of the KVG. Health insurance remained stuck at the stage it had reached in 1964.

Literatur / Bibliographie / Bibliografia / References: Bernardi-Schenkluhn Brigitte (1992), Das Gesundheitssystem der Schweiz. Akteure, Strukturen, Prozesse und Reformstrategien, in Schriftenreihe der SGGP, 24, 1-191; Uhlmann Björn, Braun Dietmar (2011), Die schweizerische Krankenversicherungspolitik zwischen Veränderung und Stillstand. Zürich; Schuler Thomas, Frei Andreas (1987), Die Teilrevision der Krankenversicherung, Aarau.