Page 67 - Bulletin, Vol.81 No.2, December 2022

2020). The tests that were paid for by the insurance system were normally then re-
invoiced to the central government. Under the federal division of powers, the
Confederation is not involved in activities related to the treatment of patients. For
inpatient treatment (hospitalisation), the costs for the cantons are estimated to be
between 284-335 million for 2020 and 341-404 million for 2021; while the insurers paid
233-274 million, respectively 279-330 million. These figures are based on an estimate of
the average cost of a day of hospitalisation. In the year 2021, 243,471 "normal" hospital
days and 67,759 intensive care hospital days were recorded, for a population of 8
million people. These figures reflect the fact that the cantons bill insurers for 45% of
hospital costs. The Federal Council warns that caution should be exercised in
interpreting these figures. It is difficult to disaggregate "real" COVID-19 hospitalisations
and patients admitted for other treatment who turn out to be positive for a COVID-19
test.
Estimating the cost of vaccination is tricky because of the complexity of the system.
Vaccines as such are first purchased (and paid for) by the Confederation, at a price
agreed in each purchase contract with the producer ("pre-financing").

The insurer then reimburses the Confederation a lump sum for the vaccines taken by
their clients. The cost of the injection is mainly borne by the cantons, as they are
responsible for running the vaccination centres.

International civil servants and diplomats residing in Geneva noted that vaccination was
free for them as well, although they are often not affiliated to a Swiss insurer.

For those without insurance, the cost of vaccination was covered by a central institution.

Similarly, for COVID-19 tests. That said, it is estimated that insurers have borne a cost
of 264 million (in 2021) for the vaccines, while the approximate cost to the
Confederation is about 600 million in 2021 (a purchase of 647 million and
reimbursements of about 45 million), plus an initial purchase of 190 million in late 2020.
Another cost site for the Confederation is material and equipment.

This item falls from 428 million in 2020 to only 19 million in 2021.

A hot topic in Switzerland is the cost that people have to pay for their health insurance
policies.

At the height of the pandemic, in 2020-2021, a number of routine treatments had to be
postponed. As a result, insurers had a positive financial result in their 2020 accounts,
and were even able to increase their financial reserves. In view of these abnormally
high reserves, the central government decided to act. On 14 April 2021, it amended a
federal ordinance to relax the conditions for returning excessive reserves to insurers'
customers.
On this basis, the Federal Office of Public Health (FOPH) has approved the
reimbursement of CHF 28 million in 2021 and CHF 380 million in 2022.

2022. The FOPH thus expects a significant drop in insurers' reserves in 2022. More
crucially, policyholders will pay less for their insurance that year, with a 0.2 per cent
reduction in real premiums and a 1.2 per cent reduction in additional reimbursement.

Nevertheless, insurers' reserves should be reduced and further reforms are needed to
control the cost of health care.

AAFI-AFICS BULLETIN, Vol. 81 No.2, 2022-12 65