Swiss health insurance for expats? No need, says government

Setting up house abroad means leaving the Swiss health insurance system; for older emigrants, this can often become a problem. Keystone / Rungroj Yongrit

When the Swiss Abroad fall ill, they often return to Switzerland for treatment. Many politicians want to tackle the issue, but the government sees no need to act.

Anyone who leaves Switzerland must leave the Swiss health insurance system. This creates difficulties for emigrants who settle outside the European Union, especially if they are elderly or already ill. For these people it is hard to find an insurer at all.

In future, however, the Swiss Abroad should be able to obtain Swiss health insurance if they want it. This is the aim of a postulateExternal link pending in parliament.

The current system has a side effect: health tourism. If expatriates become ill, they often return to the Swiss health system. In Switzerland, they are automatically insured again from the day they return.

Elisabeth Schneider-Schneiter, a parliamentarian for The Centre party, is convinced that it would be cheaper for Swiss citizens to receive treatment in their countries of residence – even if Swiss health insurance companies pay for it.

“If someone is treated in Thailand, the costs are significantly lower,” she says. She has convinced colleagues from all the relevant political parties with her argument – 35 members of parliament have signed her postulate.

Their objective is modest; for the time being, their demand is just for a report that shows how offering the Swiss Abroad the option of retaining Swiss basic health insurance could be achieved.

The government has now published its statement on this issue. It stresses two principles. The first is that health insurance is based on residence. “As a rule, premiums are paid in the country where medical services are used,” the government writes. The second principle is Switzerland’s balanced annual health budget. “The premiums of one year must cover the expected costs of the same year,” it says. According to the government, the result of these  principles is that “there is no individual health account”.

In its response, the government refers to private insurance as an option. However, it does not address Schneider-Schneiter’s observation that private insurance is “difficult to impossible” to obtain.

‘Missing a great opportunity’

Schneider-Schneiter is disappointed. “The government hasn’t addressed the real problems,” she says. “It is missing a great opportunity for a simple measure that would be a significant improvement and would have little negative impact on the health system in terms of costs.”

In its response, the government refers to an interpellation with similar content submitted in 2014. Since then, nothing has changed, it says. “The report requested by the postulate is not necessary at the current time.”

But Josef Schnyder, a member of the Council of the Swiss Abroad in Thailand, argues that a great deal has changed recently. He points out that the number of Swiss emigrants of retirement age has increased by a quarter in the past few years alone. “The laws date back to 1997, but the problem has been growing in recent years,” Schnyder says.

This issue mainly affects migrants in non-EU/EFTA countries. There are communities of Swiss pensioners abroad who depend on expensive international health insurance – particularly in Thailand, but also in the Philippines, Vietnam and Brazil. According to Schnyder, between 12,000 and 15,000 people are affected in total. The elderly or people with pre-existing conditions can find only very expensive insurance or none at all.

“We’re only talking about a very small number of Swiss abroad,” Schneider-Schneiter says.

Reader reaction

Since SWI swissinfo.ch reported on the issue, a number of people have got in touch. A 74-year-old Swiss pensioner says he hopes he has “saved enough to avoid having to return to Switzerland”. He could not find private insurance because of his age. The man had seen how his 80-year-old sister’s cancer treatment consumed the maximum sum permitted under her insurance cover.

Adrian P., a reader who travelled back to his home canton of Zug from Thailand for an operation in June, also contacted us. After ten weeks in hospital, he has not yet received a certificate of residence from his home municipality of Zug, which he needs for Swiss health insurance.

“My hometown is denying me the right to settle here,” he writes. He suspects the reason is “purely to do with money. The richest canton in the country is worried about money. What a sorry state of affairs”. He says he paid health insurance and taxes for 37 years.

Another emigrant is Matthias A., who before his retirement worked as a humanitarian aid worker on assignment for the International Committee of the Red Cross (ICRC) and the Swiss government. He battled in vain to get Swiss insurance in Thailand. Now he has found insurance with an international company.

“These companies are profit-oriented,” he says. “They can raise premiums significantly at any time.” He says it is impossible to plan his finances well for the future and notes that his money is now going to international companies.

“I would have preferred a Swiss solution,” he says. After all, he adds, as a humanitarian aid worker abroad, he represented Swiss values all his life.

Edited by David Eugster. Translated from German by Catherine Hickley

Pattaya in Thailand: many Swiss living in Southeast Asia have trouble finding a good health insurance option. Keystone / Narong Sangnak