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Short shrift given to Managed Care at ballot box

Voters have thrown out a highly divisive proposal to limit increasing healthcare costs as well as initiatives to give the electorate a bigger say on foreign policy treaties and plans to boost home ownership with tax breaks.

None of the three issues won more than 31 per cent in Sunday’s nationwide ballot and no language region or individual canton recorded a majority in favour.

“It is a rather devastating verdict particularly for the proposal by parliament and the government to boost Managed Care systems,” says political scientist Claude Longchamp.

He adds that neither the rejection of the health plan nor the refusal of the other issues comes as a surprise.

The proposals were rather complex and the campaigns confusing, as was the case with Managed Care, or they had only limited potential to stir emotions according to Longchamp.

Turnout was below average, at 38 per cent.

Interior Minister Alain Berset, whose portfolio includes health issues, described the outcome – a rejection rate of 76 per cent – as a missed opportunity to halt rising health costs. “It shows once more how difficult it is to introduce reforms in this sector,” he told a news conference.

Berset also noted a “certain ambiguity” as all sides persistently called for better coordination and cooperation in the medical sector, but the compromise forged by an alliance of supporters was undermined by divisions among doctors organisations and political parties.

He said the government would consider boosting e-health projects and the system of family doctors.

Managed Care

There are already about 90 Managed Care networks in the country, particularly in German-speaking urban areas, but the ultimate goal of the government and parliament was to have about 60 per cent of the population covered by Managed Care.

They wanted to do this by creating clusters of doctors, therapists, hospitals and pharmacies. This was arguably the most contentious matter in the run-up to the vote.

These networks  negotiate binding budgets with health insurance companies, with GPs as gate-keepers for patients. Those people opting out and insisting on a unlimited access to medical services would have faced higher bills.

Supporters of Managed Care argued it would result in spending cuts of about SFr1 billion ($1.05 billion) annually and help improve the quality of healthcare. The sector saw costs increase by about 50 per cent over the past 15 years.

However, opponents said it would result in a two-tier system at the expense of the less affluent population and specialist doctors. A key argument brought forward was that patients would lose access to a doctor of their choice.

It was also pointed out that the impact of Managed Care in other countries has been highly controversial.


In their campaign opponents had warned patients free access to medical services was at stake.

The Managed Care plans were aimed at boosting networks of doctors and other providers of medical services. These clusters would negotiate binding budgets with health insurers.

In a bid to reduce health costs opponents now moot scrapping of the mandatory basic health insurance coverage, introduced in 1996; or for certain doctors to be excluded from the insurance system, but experts doubt they stand a chance of winning a majority in parliament.

Other projects on the table include the introduction of a single health insurance company, a special scheme for the chronically ill or for higher financial contributions from the cantons to the health sector.

Most health reforms in Switzerland in the past two decades have failed in parliament or at the ballot box, but costs have risen by about 50 per cent in the same period.

“We have a good health system, accessible for all and envied by all even if it comes at high costs,” said Berset.




This content was published on Laws which have been adopted by parliament can be challenged by the public in a referendum. For such a ballot to take place, at least 50,000 signatures must be gathered within 100 days. The so-called optional referendum needs only a majority of votes to be passed in a nationwide poll. The electorate also has the…

Read more: Referendum


The international treaties initiative by a conservative pressure group close to the rightwing Swiss People’s Party was rejected by three out of four voters. The organisation, which is known for its anti-European Union stance, wanted to limit the powers of the government and parliament on foreign policy issues.

The result shows the confidence of voters in the existing system of direct democracy, as parliamentary decisions can be challenged in referendums to a nationwide vote according to Justice Minister Simonetta Sommaruga.

The government, most political parties and the business community argued the initiative would lead to an unmanageable number of votes on mostly technical treaties every year and damaging Switzerland’s reputation as a negotiating partner.

The Campaign for an Independent and Neutral Switzerland, which was behind the initiative, said it would now make more frequent use of referendums. It confirmed the launch of a referendum against tax treaties with Germany, Britain and Austria, endorsed by parliament last week.

Home ownership

Voters also gave short shrift to a proposal by a home owners’ association seeking tax breaks for people putting money aside to purchase a house or an apartment.

The initiative – the second proposal to come to a vote this year – only had the support of 31 per cent of the electorate.

Finance Minister Eveline Widmer-Schlumpf said the public obviously saw no need for such plans to boost home ownership, which is considerably lower than in other European countries.

Nevertheless, in September voters will again decide on a proposal to grant tax privileges for home owners at retirement age.

Managed Care:

24% yes     76% no

International treaties:

24.8% yes   75.2% no

Home ownership:

31.1% yes   68.9% no

Turnout: 38%

It was the second in a series of nationwide ballots this year.

Numerous votes on a variety of issues also took place at cantonal and local levels.


As part of ongoing trials with e-voting, around 165,000 citizens, including about 90,000 Swiss abroad, were given the choice to cast their ballots online.

About 50% of them used the possibility, according to the Federal Chancellery.

Of the nearly 180 initiatives put to nationwide votes in the history of modern day Switzerland only 19 won approval by voters.

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SWI - a branch of Swiss Broadcasting Corporation SRG SSR