Free choice of hospital

What is free choice of hospital?

Free choice of hospital is your right to choose the hospital yourself for inpatient treatment, including in another canton. The condition is that the hospital is on a hospital list: that of your canton of residence or that of the canton in which the hospital is located. Such hospitals are called listed hospitals.

The rule has applied since the revision of hospital financing that came into force on 01.01.2009. Before that, choosing a hospital outside your canton of residence was severely restricted in basic health insurance. Today, for example, as a person from Aargau you can choose a listed hospital in Zurich or Bern.

It is important to distinguish it from two similar terms. Free choice of hospital concerns the choice of hospital. Free choice of doctor in hospital, i.e. choosing the head physician, and a single or two-bed room are not part of basic health insurance but of supplementary hospital insurance under the Insurance Contract Act (ICA). Basic health insurance covers the stay in the general ward.

You also have free choice for outpatient treatment: you choose freely among the licensed doctors, therapists and hospital outpatient departments that are suitable for your treatment. The insurer pays according to the tariff that applies to the chosen service provider. You only restrict this freedom if you choose an alternative insurance model such as the GP or telemedicine model.

How it works

The costs of inpatient treatment are shared between two payers: the canton of residence and the health insurer. The canton pays at least 55%, the insurer the rest. On top of that come your deductible, the retention fee and the hospital contribution of CHF 15 per day.

If you choose a listed hospital outside your canton, the canton and the insurer pay at most the amount that the same treatment would cost in a listed hospital in your canton of residence. If the tariff of the chosen hospital is higher, a difference arises. Basic health insurance does not cover it. Some supplementary hospital insurance policies do, for example products with “general ward throughout Switzerland” cover; this is governed by the contract.

It is different where there are medical reasons. These exist in an emergency or if the necessary treatment is not offered in any listed hospital in your canton of residence. The insurer and the canton then pay the full tariff of the hospital providing the treatment. Except in an emergency, this requires an authorisation from your canton of residence.

Listed hospitals must admit patients from the canton in which they are located. For people from other cantons, the obligation to admit applies only within the scope of their service mandates and in emergencies. So the hospital can turn you down for a plannable treatment if it has no capacity.

Legal basis

Art. 41 para. 1bis of the Federal Health Insurance Act (KVG) gives you the choice among the hospitals on the hospital list of your canton of residence or of the canton where the hospital is located. The insurer and the canton of residence share the remuneration in proportion under Art. 49a KVG, at most according to the tariff that applies in a listed hospital in the canton of residence. Art. 41 para. 3 KVG governs treatment for medical reasons in a hospital that is not on the list of the canton of residence; except in an emergency, an authorisation from the canton of residence is required. Art. 41 para. 3bis KVG defines what medical reasons are. The outpatient choice is set out in Art. 41 para. 1 KVG, and the restriction through alternative models in Art. 41 para. 4 KVG.

Under Art. 49a para. 2ter KVG, each canton sets its share for the calendar year at the latest nine months before the year begins; it must be at least 55%. The obligation of listed hospitals to admit patients is set out in Art. 41a KVG. That basic health insurance covers the stay in the general ward follows from Art. 25 para. 2 let. e KVG.

Example: an operation in a neighbouring canton

Marco is 58, lives in canton A and has a planned operation carried out in a listed hospital in canton B. The amounts are assumed for the calculation; the split follows the law. The same treatment would cost CHF 10,000 in a listed hospital in his canton of residence and CHF 11,200 in the chosen hospital. His canton has set a share of 55%, the statutory minimum.

Item	Amount
Tariff of the chosen hospital in canton B	CHF 11,200
Applicable tariff in canton of residence A	CHF 10,000
Share of canton A (55% of CHF 10,000)	CHF 5,500
Share of the health insurer (45% of CHF 10,000)	CHF 4,500
Uncovered difference	CHF 1,200

What this means for you

Free choice of hospital gives you choice, but no guarantee on costs. Before a plannable treatment outside your canton, clarify three questions:

1. Is the hospital on a hospital list? Only listed hospitals bill in full through basic health insurance. Different rules apply to a contract hospital.
2. Will there be a tariff difference? Ask the hospital in writing whether its tariff is higher than that of your canton of residence.
3. Does your supplementary insurance cover the difference? Check your policy or compare offers under Compare supplementary insurance.

If you have an alternative model, such as GP or telemedicine, free choice of hospital still applies. But the referral usually has to go through the agreed first point of contact; this is set out in the insurance conditions. You can see which insurer offers which models under health insurers, and the 2026 premiums in the premium calculator.

Common mistakes

• Confusing free choice of hospital with free choice of doctor. Basic health insurance lets you choose the hospital, not the head physician.
• Assuming every hospital is covered. Private clinics without a place on a hospital list do not bill in full through basic health insurance.
• Overlooking the tariff difference. Outside your canton of residence, the insurer and the canton pay at most your canton’s tariff.
• Forgetting the authorisation. If, for medical reasons, you want the full tariff of a hospital that is not on your canton’s list, you need an authorisation from your canton of residence beforehand, except in an emergency.

You can find more terms related to hospitals and financing in the glossary, for example on the cantonal share.