Cantonal share

What is the cantonal share?

The cantonal share is the contribution that the canton of residence makes towards the cost of inpatient treatment, i.e. a hospital stay with an overnight stay. Since the new hospital financing system was introduced, the canton and the health insurer share every inpatient bill from a hospital on the Hospital List according to a fixed formula. The canton finances its part from taxes, the insurer its part from basic health insurance premiums.

The law requires the canton to bear at least 55%. The health insurer therefore bears at most 45%. Each canton can set a higher share. The canton of Zurich has stayed at the minimum of 55% since 2017, while the canton of Zug pays 99% in 2026 and 2027.

The cantonal share only applies to inpatient services in hospitals, birth centres and for acute and transitional care, provided the institution is on a cantonal Hospital List. Today, outpatient treatment, including in hospital, is paid for by the health insurer alone. For hospitals without a service mandate, known as contract hospitals, there is no cantonal share.

How it works

In acute somatic care, the reimbursement for an inpatient stay is based on a flat rate per case under SwissDRG. The canton and the insurer share this flat rate:

1. Setting the share. Each canton sets its share for the calendar year no later than nine months before it starts. This way, hospitals and insurers know early on which formula to use.
2. Splitting the bill. The hospital bills the insurer for its share. The canton of residence pays its share directly to the hospital. The canton and the insurer can also agree that the canton pays the insurer, which then transfers both shares to the hospital.
3. Co-payment. For you, the deductible, the retention fee and the hospital contribution apply, as with any other basic health insurance benefit.

For a hospital stay in another canton, your canton of residence also pays its share if the hospital is on the Hospital List of your canton of residence or of the canton where it is located. The canton and the insurer then pay at most the tariff that applies in a listed hospital in your canton of residence. You or a supplementary insurance must bear the difference to a more expensive tariff, unless there are medical reasons, such as an emergency. You can read more about this under free choice of hospital.

Uniform financing from 2028

On 24 November 2024, voters approved the uniform financing of services (EFAS) with 53.31% voting yes. From 2028, outpatient and inpatient services will be financed in the same way, and from 2032 long-term care as well. The cantons will then pay 26.9% of the net costs, i.e. after deducting the co-payment, to the insurers; 73.1% will be financed through premiums. The current cantonal share of at least 55% of inpatient bills will then no longer apply.

Legal basis

Art. 49a para. 1 of the Federal Health Insurance Act (KVG) states that the canton and the insurer each cover a share of the reimbursement for inpatient treatment. Under para. 2, the canton pays the share for insured persons who live in it and for certain insured persons resident in the EU, such as cross-border commuters. Para. 2ter requires each canton to set its share no later than nine months before the start of the calendar year and states that the share must be at least 55 per cent. Para. 3 governs payment directly to the hospital. Para. 3bis distributes the share for pensioners resident in the EU among all cantons according to their population.

Art. 41 para. 1bis KVG gives you free choice among the listed hospitals of your canton of residence and of the canton where the hospital is located, and limits the reimbursement to the tariff of a listed hospital in your canton of residence. Art. 41 para. 3 KVG governs cover where there are medical reasons. The figures for uniform financing from 2028 (26.9% cantons, 73.1% premiums) come from the KVG amendment of 22 December 2023, as summarised by the Federal Office of Public Health (FOPH). The cantons publish their cantonal shares themselves.

Example: same treatment, two cantons

Let us take an inpatient stay with a reimbursement of CHF 12,000 in a listed hospital in the canton of residence, in 2026. The amount is a sample calculation; the shares are the published figures of the cantons of Zurich and Zug.

What this means for you

You do not choose the cantonal share; it depends on your canton of residence. It matters to you in three places:

1. Understanding premium differences. Where the canton pays more towards hospital costs, the insurer has to finance less from premiums. This is one of several reasons why premiums differ from canton to canton. You can see the premiums for your municipality in the premium calculator.
2. Checking your choice of hospital. If you go without a medical reason to a hospital that is not on the Hospital List of your canton of residence or of the canton where it is located, there is no cantonal share. A hospital on another canton’s list is possible, but at most the tariff of your canton of residence is paid.
3. Choosing supplementary insurance deliberately. Depending on the contract, supplementary hospital insurance can cover differences for treatment in another canton or in contract hospitals. The profiles under health insurers show which insurers offer this.

Common mistakes

• Thinking the cantonal share is a discount from the insurer. It is the canton’s tax money and has nothing to do with your contract.
• Believing the canton also pays for outpatient treatment. Until the end of 2027, premiums alone finance outpatient treatment.
• Thinking every hospital is equivalent. Only listed hospitals receive the cantonal share. In contract hospitals, basic health insurance pays at most 45%.
• Thinking EFAS is already in force. Uniform financing only applies from 2028, and for long-term care from 2032.

We explain how we present premiums and costs under How we calculate.