Range of benefits

Compared with other countries, Switzerland has a uniform and generous range of benefits, covering everything reimbursed by the statutory health insurance (SHI) system. Its broad scope limits the transfer of costs and ensures that the entire population has access to high-quality medical care.

Medical services and products must meet the WZW criteria (the acronym derives from the German words) of effectiveness, appropriateness and cost-effectiveness before they can be included in the range of benefits provided by the statutory health insurance system and thus reimbursed by the health insurers. The Health Insurance Act (HIA) requires the included benefits to be reviewed periodically. This task falls to the Federal Office of Public Health (FOPH). The FOPH examines new benefits and products at the manufacturer’s request; the manufacturer must provide evidence that they comply with the WZW criteria. If they are assessed positively by the FOPH, medicinal products are included in the List of pharmaceutical specialities (LS); this list contains all the medicinal products and therapies reimbursed under basic health insurance.

Curative benefits are covered by basic health insurance provided they have not been specifically excluded. The manufacturer must also provide evidence of the effectiveness, appropriateness and cost-effectiveness of medicinal products, laboratory analyses and other agents used for examination and treatment purposes if the intention is for them to be covered and reimbursed under basic health insurance.

Complementary medicine

In 2017, regulations came into force that put complementary medicine benefits on an equal footing with the other medical benefits provided by the SHI system. Under certain conditions (a tradition of use and research, scientific evidence and medical experience, postgraduate medical training), medical care provided by doctors practising anthroposophic medicine, traditional Chinese medicine, homeopathy and plant-based therapy are accepted in good faith and reimbursed by the SHI system. The principle of good faith presupposes that doctors only provide services that fulfil the requirements for effectiveness, appropriateness and cost-effectiveness. As with other branches of medicine, only certain, controversial services undergo scrutiny.