• social insurance;
  • health policy;
  • political aspect;
  • social security administration;
  • Switzerland


The foundations of Switzerland's social insurance system can be traced to 1890 when a public referendum voted the inclusion of an article into the Federal Constitution that gave the executive the task of creating a sickness and accident insurance scheme. Currently, as in other European countries, the Swiss social insurance system is facing challenges as a result of rising health costs and demographic shifts, which are placing a growing burden on both public finances and private households. To reach policy decisions to address these challenges, the Swiss system is distinguishable from those of its European neighbours because of a continuing tradition of political decision-making based on grass-roots democracy: through referenda, the Swiss people remain directly responsible for the development of the national social insurance system. Importantly, not only might this unique feature of Swiss democracy lead the Swiss people more readily to accept and identify with their social insurance system but it may offer a sound democratic base upon which to build a consensual approach to address the policy challenges that lie ahead.