Cost brake initiative

What is the cost brake initiative?

The cost brake initiative, officially the popular initiative “For lower premiums – cost brake in the healthcare system” (Kostenbremse-Initiative), was a federal popular initiative of the Centre party, submitted in 2020. It sought to curb the costs of basic health insurance by linking their growth to the development of wages and the economy as a whole. If costs had grown considerably faster, the Confederation and the cantons would have had to intervene.

The background is the development of costs. According to the FOPH, the costs of basic health insurance per person rose by 31% from 2012 to 2022, while nominal wages rose by 6% over the same period. Since the Federal Health Insurance Act (KVG) was introduced in 1996, the gross costs of basic health insurance have grown by 302%. Because premiums must cover costs, premiums rise along with healthcare costs.

The Federal Council and Parliament shared the aim but rejected the initiative. They argued that the mechanism was too rigid and did not take account of factors such as the ageing population or medical progress. On 09.06.2024, the people and the cantons rejected the initiative with 62.77% voting no. The premium relief initiative also failed on the same day.

An indirect counter-proposal has been in force since 01.01.2026: an amendment to the KVG that introduces cost and quality targets. It is one of a series of cost containment measures.

How it works

What the initiative would have required: the Confederation, the cantons, health insurers and service providers would have had to ensure that costs did not rise much faster than wages and the economy as a whole. If, two years after its adoption, costs had grown more than 20% faster than wages and the tariff partners had not taken action, the Confederation and the cantons would have had to adopt cost-containing measures taking effect the following year. Parliament would have had to lay down the details in law.

What the counter-proposal governs:

1. Federal targets: after consulting insurers, insured persons, cantons and service providers, the Federal Council sets cost and quality targets for basic health insurance benefits for four years at a time.
2. Deadline: the targets must be set no later than twelve months before the start of the period.
3. Cantonal targets: each canton can set its own cost and quality targets; in doing so, it must take the Federal Council’s targets into account and consult insurers, insured persons and service providers.
4. Monitoring: a federal Commission for Cost and Quality Monitoring monitors the development of individual areas of benefits, issues recommendations to the Confederation and the tariff partners and publishes its decisions.

The first targets are set for the calendar year that begins two years after the entry into force. With entry into force on 01.01.2026, that is 2028. Because the targets must be set twelve months in advance, the Federal Council will set them by the end of 2026 at the latest.

Legal basis

The initiative would have amended the Federal Constitution; it was rejected. The law in force is the counter-proposal, the KVG amendment of 29.09.2023 “Cost containment measures – setting cost and quality targets”, in force since 01.01.2026:

• Art. 54 KVG: after consulting insurers, insured persons, cantons and service providers, the Federal Council sets cost and quality targets for four years at a time.
• Art. 54a KVG: each canton can set its own targets for four years, taking the Federal Council’s targets into account; it first consults insurers, insured persons and service providers.
• Art. 54b KVG: the targets are set no later than twelve months before the start of the period.
• Art. 54c KVG: a federal Commission for Cost and Quality Monitoring monitors the areas of benefits, issues recommendations and publishes its decisions. Insurers, insured persons, cantons, service providers and experts are represented on it.
• Transitional provision: the targets are set for the first time for the calendar year that begins after two years have elapsed since the entry into force.

According to the FOPH, the Federal Council decided on 26.11.2025 to bring the amendments to the KVG and KVV into force on 01.01.2026.

Example: how the initiative’s mechanism would have calculated

The initiative was rejected, but its mechanism helps to understand the debate. The growth rates in the table are illustrative values, not forecasts. The rule: intervene if cost growth is more than 20% above wage growth.

What this means for you

The counter-proposal works in the long term and indirectly. It changes nothing measurable for your premium next year. What you can influence yourself:

• Compare premiums: premiums differ considerably within the same municipality depending on insurer, deductible and model. In the premium calculator, you can see all offers with the official FOPH data.
• Consider switching: by changing insurer, deductible or model, you lower your premium directly. Dates and procedures are listed under switching insurer and deadlines.
• Know the insurers: you can find the insurers’ reserves and administrative costs under health insurers.
• Follow developments: the Commission for Cost and Quality Monitoring publishes its decisions. We report on new targets and premium rounds under news.

Common mistakes

• Believing there is a cost brake. The initiative was rejected. What is in force are targets and monitoring, not an automatic brake.
• Expecting an immediate effect. The first targets apply to 2028.
• Equating costs and premiums. The targets concern cost growth. Premiums follow costs, but reserves and risk equalisation also play a part.
• Confusing the two initiatives. The cost brake targeted costs, the premium relief initiative the premium burden on households.

How we analyse premiums and costs is explained under how we calculate.