Hospital treatment

People with health insurance basically have a free choice of hospital for inpatient hospital treatment. The cantons and health insurers cover the costs of hospital treatment. Insureds have to pay a share of the costs of hospital treatment themselves.

The following information also applies analogously to birth centres.

What hospital can I go to for treatment?

Choice of hospitals 

The cantons are obliged to do hospital planning to cover their residents' inpatient treatment requirements. On the basis of this planning, the cantons draw up lists of hospitals necessary to assure the scheduled provision of treatment. A canton's list of hospitals can contain hospitals both in the canton itself and in other cantons.

Insureds have a free choice of the following hospitals:

  • Hospitals on the list of the canton in which the insured person lives (listed hospital in canton of residence)
  • Hospitals on the list of another canton (listed hospital in another canton)
  • Hospitals that are not on any cantonal list but have a contract for the reimbursement of mandatory basic health insurance benefits (contractual hospital).

Information on individual hospitals

The FOPH provides information on Swiss hospitals (primarily key figures and quality indicators) to help patients choose their hospital.

What will I pay for hospital treatment?

Cost share paid by the insured person

People with health insurance must pay a share of the costs of the care and services they receive. In the case of inpatient hospital treatment, this cost share comprises the insured person's chosen deductible, the general copayment, and a contribution for each day they are in hospital. The insured person will be billed the corresponding cost share by their health insurer.

The insured's health insurer and canton of residence each pay a fixed percentage of the costs of inpatient hospital treatment (including hospital accommodation and nursing care). The canton of residence pays a minimum of 55 per cent, and the health insurer a maximum of 45 per cent. The hospital usually issues two bills for the inpatient treatment provided: one to the canton (for at least 55 per cent of the total amount), and one to the health insurer (for up to 45 per cent of the total). The insured person receives a copy of the bill sent to and paid by the health insurer (under the so-called third-party payer or tiers payant system).

Additional costs paid by the insured person

Depending on the treatment and chosen hospital, insureds may have to pay additional costs themselves or have them paid by their supplementary insurance.

No additional costs are paid in the following cases:

  • The insured has treatment in an appropriate hospital on the list of their canton of residence.
  • The insured has treatment at a hospital that is not on their home canton's list on medical grounds because there are no hospitals on their home canton's list able to provide the required care. However, in such cases a commitment to provide cover must be sought in advance.
  • The insured has treatment in an emergency at a hospital not on their home canton's list.

Additional costs are most likely to be incurred if the insured chooses a listed hospital that is not on their home canton's list or a contractual hospital, and if neither of the medical grounds described applies (i.e. it is not an emergency or a situation where the treatment cannot be provided by any listed hospital in the home canton).

If the insured chooses a listed hospital in another canton, the rule is that their health insurer and canton of residence share the costs of inpatient treatment up to an amount not exceeding the tariff applicable to a listed hospital in the home canton. If the tariff of the chosen listed hospital in another canton is higher than the tariff for a listed hospital in the canton of residence (c.f. the reference tariffs for hospitalisation outside the canton of residence), the insured must pay the difference themselves or have it paid by their supplementary insurance.

The canton does not pay a share of the costs if the insured chooses a contractual hospital. In this case the health insurer covers up to 45 per cent of the costs of hospital treatment. The remainder must be covered by the insured person or their supplementary insurance.

Last modification 11.03.2019

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Contact

Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Tariffs and Principles Division
Schwarzenburgstrasse 157
3003 Berne
Switzerland
Tel. +41 58 462 21 11
E-mail

Print contact

https://www.bag.admin.ch/content/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Spitalbehandlung.html