Swiss health-insurance premiums are going up again. Average compulsory premiums will rise by 5% in 2027, to CHF 412 (US$ 500) a month. Anyone wondering what they will pay next year can check the federal government’s premium calculator.
One common explanation for the relentless increase is Switzerland’s ageing population. Older people consume more medical care, so an older population should spend more on doctors, hospitals and drugs. Both intuition and the data support that argument. But the large differences between cantons suggest that ageing is only part of the explanation—and perhaps not the most important one.
Health spending rises sharply with age. Average compulsory-insurance payouts are about CHF 1,600 a year for young children and roughly CHF 2,500 for people in their early 40s. Costs then accelerate. They reach about CHF 4,400 for those aged 56-60 and CHF 5,500 for 61-65 year-olds. Thereafter the curve becomes much steeper, exceeding CHF 20,000 for people over 90.
Some cantons fit the simple story. Ticino has one of Switzerland’s oldest populations and among its highest health costs. Zug is relatively young and cheap. But across the country the relationship quickly breaks down.
Geneva, for example, has the youngest population by the share aged 65 and over, yet has the second-highest compulsory-insurance spending per person. More strikingly, seven of the 13 cantons with the oldest populations are also among the 13 cheapest in terms of compulsory-insurance payouts: Graubünden, Nidwalden, Uri, Glarus, Appenzell Ausserrhoden, Appenzell Innerrhoden and Obwalden.
Age clearly matters. But Swiss studies repeatedly find that demographics explain only part of the large geographical variation in health spending. Much of the gap between high- and low-cost cantons remains after differences in age and other population characteristics are taken into account.
That raises a more interesting question: what else is driving the divergence?
One clue is urbanisation. Health spending tends to be higher in densely populated cantons, where doctors, specialists and hospitals are more plentiful.
A study of cantonal health-care use that controlled for demographic and socio-economic differences found that older populations did use more care, as expected. But provider supply and population density also had large independent effects. The differences in specialist use were striking. Residents of Basel-Stadt averaged about 2.1 specialist consultations a year, compared with roughly 0.7 in Uri, Obwalden and Nidwalden. Outpatient-hospital use showed a similar pattern: around 2.7 contacts per person in Basel-Stadt against about 0.6 in Schwyz. A another study found higher use of outpatient care in urban regions.
That points to a supply effect. Switzerland’s econometric literature is fairly consistent on this. Cantons with older populations tend to spend more, but so do those with more doctors. Under fee-for-service medicine, greater supply can generate greater use: when specialists, scans and outpatient clinics are easier to access, patients tend to consume more of them.
Switzerland’s cantons therefore offer something close to a natural experiment in how the supply of medicine affects the demand for it. Uri, Graubünden, Basel-Stadt and Geneva are particularly revealing because their rankings by age and by health spending diverge so sharply.
An ageing population is undoubtedly pushing Swiss health costs higher. But the cantonal evidence suggests that where people live—and how much medicine is available to them—may matter more than how old they are.
For more stories like this on Switzerland follow us on Facebook and X.
