‘Just back for a short visit’: politician wants to end healthcare tourism

In Switzerland healthcare is very expensive: treatment in a hospital in Zurich. © Keystone / Michael Buholzer

The Swiss Abroad can end up being expensive to Switzerland. If they fall ill, they often return to the Swiss healthcare system. Things could be done differently, says politician and Swiss Abroad advocate Elisabeth Schneider-Schneiter. Her idea is to get broad support in parliament.

The Swiss population is groaning under the weight of soaring healthcare costs. According to an opinion survey by Tamedia press last week, this is the major problem the country’s leaders need to tackle. For Elisabeth Schneider-Schneiter, the Swiss Abroad need to be part of the solution.  

Among them are many retirees, who often need costly treatment. Retirees resident abroad often come back to Switzerland to get their health needs looked after. Especially if surgery or a major course of treatment is planned.  

“Swiss Abroad register for a half-year’s residence back in Switzerland and get costly surgery here,” says Schneider-Schneiter, “which is a real challenge for the system.” The Centre Party member of the House of Representatives is also on the board of the Organisation of the Swiss Abroad (OSA).  

Politician and Swiss Abroad advocate Elisabeth Schneider-Schneiter. zvg

There is a problem with this kind of healthcare tourism. Patients get services paid for by the Swiss health insurers, services which – at first sight anyway – they have not contributed to.

Legally exploit the system

People who take up residence abroad have to exit the Swiss healthcare system with its rights and duties. They pay no more health insurance premiums, but they lose the right to healthcare in Switzerland.

As it happens, there is an easy way around this. If they take up residence in Switzerland again, they have to start paying health insurance contributions – and thus become entitled to receive the full range of healthcare.

All you have to do is take up residence again for a minimum period in Switzerland and you’re back – at no cost to  you – in one of the most expensive and high-quality healthcare systems in the world. It’s all quite legal. The fault, if there is one, lies in the system itself.  

“If someone is treated in Thailand, the treatment costs are significantly lower.”

Elisabeth Schneider-Schneiter

How often this happens is hard to determine. There is evidence, however, that it is actually quite common. The Swiss health insurance company KPT, which traditionally handles most of the health insurance requirements of Swiss expats, finds no great difference in the costs they have to assume whether their customers live in expensive countries like Japan or countries where healthcare is cheap, like Tunisia or Brazil.

That suggests that Swiss Abroad, living in a country where healthcare is not really top-quality, tend to come back to Switzerland for medical treatment, as SWI swissinfo.ch found out in a 2019 investigation.  

The special case of Thailand

Talk around the community of Swiss Abroad definitely suggests that healthcare tourism is mainly resorted to by people in Thailand and the Philippines.

The issue seems to arise only when the health insurance system in the country of residence is so different that there is a strong incentive for homeward-bound healthcare tourism.

In EU and EFTA countries this is not the case. Thailand, on the other hand, is a special case, because it has a strong appeal for Swiss pensioners and early retirees, mostly men. Low cost of living, tropical climate and easy availability of visas are all factors in its favour; another draw is widespread prostitution.

As many as 6,000 Swiss seniors and early retirees live in Thailand. Many of these have come up against an unforeseen problem since the pandemic.

Since December 2022 residence in Thailand requires them to have a health insurance policy to cover treatment costs up to $100,000 (CHF87,539). When Covid-19 was at its height, Thailand’s healthcare system was stressed to the limit – and it is now stuck with a lot of unpaid bills.  

Thailand’s health system reached the limit of its capacity during the pandemic: Bangkok in April 2021. Keystone / Narong Sangnak

The private-sector health insurance cover available in Thailand can be quite expensive for foreign residents over 70. The older the customer, the higher the premiums. An 80-year-old might end up paying up to CHF40,000 ($45,693) a year.  

Retirees who go abroad because their budget can’t cope with the high cost of living in Switzerland tend not to be in a position to absorb these new costs. If there was a previous history of illness, they may not even be able to get health insurance at all.  

Involuntary return

In Thailand these cash-strapped retirees now have a choice between continuing to reside illegally under the radar – or having to go back home. For some time now the Swiss community in Thailand has been lobbying on the political level for a solution to be found.  

Schneider-Schneiter has taken up this issue as a member of the House of Representatives. She proposed in a parliamentary initiativeExternal link that Swiss Abroad should have the option of maintaining their Swiss basic health insurance cover. This is certainly not cheap. But compared to private-sector insurers abroad, it has the advantage that the premiums do not keep rising with the person’s age. 

Schneider-Schneiter thinks the government should allow this option, as she finds it “appalling that a Swiss citizen has been paying into the basic health insurance scheme their whole life and may never have received benefits” before they retired and went abroad. 

Health insurance benefits

Her argument can actually be quantified: Swiss retirees in Thailand relieve the burden on Swiss health insurers to the tune of CHF250 million. This calculation was made by Josef Schnyder, vice-president of the Swiss Society of Bangkok.

Schnyder notes that younger contributors to the insurance plan are really paying for healthcare in advance as a kind of compulsory solidarity with older contributors. They are paying premiums for services that they won’t consume, or will only consume when they are old.  

If someone emigrates before the age of 60 – which is just when high healthcare costs typically begin to be incurred – they have paid up all their contributions, but won’t get anything back. “As it stands, based on statistical data, the insurer makes a profit of almost CHF42,500 per insured person,” concludes Schnyder. If there are 6,000 retirees living over in Thailand, that comes to CHF250 million. 

Schnyder tells of Swiss people who have had to leave family behind in Thailand for health reasons to go back to Switzerland for treatment. He knows of people who can’t get a long-term residence permit any more, because they can’t show proof of insurance. 

Lower treatment costs

As a member of the Swiss Abroad Council, Schneider-Schneiter is in close contact with Swiss in other countries. However, her initiative in parliament is mainly targeted at bringing down Swiss healthcare costs. “If people get their healthcare in Thailand, it will cost a lot less,” she points out. 

Schneider-Schneiter has been able to persuade politicians in all the main parties of her position. Already 35 of them have endorsed her initiative, including some party leaders. “They all realise that this will mean a reduction of the burden on the Swiss healthcare system,” she says.

An international hospital in Bangkok: healthcare in Thailand is good and cheap. Keystone / Rungroj Yongrit

She is now waiting to see how the government responds to her proposal. Meanwhile, there is a further cost argument: if elderly, impoverished Swiss people in Thailand have to travel back to Switzerland, they are also likely to become a burden on the social welfare system. 

Therefore, their return means extra costs not only for the healthcare system but also for Swiss taxpayers generally.  

‘Giving the government a big break’ 

A year ago, when SWI swissinfo.ch spoke on this topic with Johannes Matyassy, then head of the foreign ministry’s consular directorate, he said: “People choose to live in countries where they can live well on a Swiss pension. But if it doesn’t work out, should the state really step in?” Matyassy found this a “problematic expectation”. 

Schneider-Schneiter now says: “Quite the contrary. The government doesn’t have to look after them. In fact, as it stands, they are the ones giving the government a big break.” 

Translated from German by Terence MacNamee