Single health insurance fund and public fund: votes, Geneva and Vaud

Single fund, public fund, uniform premium: three terms

Three things are often mixed up in the debate. A single health insurance fund would be one health insurer that provides basic health insurance for the whole population and replaces today’s insurers. A cantonal public fund would be an insurer owned by the canton; depending on the proposal, either as a compulsory fund for all residents or as an additional option alongside the existing insurers. A uniform premium already exists: each insurer charges everyone the same premium in the same region, age group and deductible (Art. 61 para. 1 of the Federal Health Insurance Act, KVG).

All proposals concern only basic health insurance under the KVG. Supplementary insurance under the Insurance Contract Act was not covered by any of the proposals.

How the current system works

Under Art. 117 of the Federal Constitution, the Confederation issues regulations on health and accident insurance. In the KVG, it has designed health insurance as compulsory insurance with several insurers. You choose freely among the licensed insurers (Art. 4 KVG). An insurer is licensed if it holds authorisation from the supervisory authority (Art. 4 KVAG). Health insurance funds are legal entities under private or public law that do not pursue a profit motive in basic health insurance (Art. 2 para. 1 KVAG); to be authorised, they must, among other things, have one of the legal forms listed in Art. 5 KVAG and hold sufficient reserves.

Each insurer sets its own premiums and the Federal Office of Public Health (FOPH) approves them. Because insurers with many young, healthy insured persons would have lower costs, risk equalisation evens out differences between their insured populations by age, sex and other illness indicators (Art. 16 KVG). In addition, each insurer must hold reserves so that it can meet its obligations even in a bad year.

The 2026 premiums in the two cantons currently examining public models show how large the differences are despite identical benefits. Adults born in 1990, CHF 300 deductible, with accident cover; source FOPH:

The FOPH publishes the next year’s premiums at the end of September; until they are released, we calculate with the 2026 premiums.

The popular votes of 2007 and 2014

Twice in the last two decades, the people and the cantons have voted on a single health insurance fund. Both times, it was a federal popular initiative, i.e. an amendment to the Federal Constitution.

Vote	Proposal	Yes	No	Share yes	Cantons	Turnout
11.03.2007	“For a social single health insurance fund”	641,917	1,590,213	28.8 %	2 yes, 18 6/2 no	45.9 %
28.09.2014	“For a public health insurance fund”	933,012	1,512,036	38.2 %	4 yes, 16 6/2 no	47.2 %

2007: The initiative called for a single fund for basic health insurance and for premiums based on insured persons’ financial capacity instead of per-capita premiums (Federal Council dispatch, Curia Vista 05.089). The cantons of Neuchâtel (51.3 % yes) and Jura (57.7 % yes) voted in favour. The part on income-based premiums is a separate topic today; more on this in the article Income-based premiums.

2014: The initiative sought to replace the 61 insurers then offering basic health insurance with a public single fund of the Confederation, with cantonal or intercantonal agencies setting and collecting the premiums; the premium was to be uniform within each canton (Curia Vista 13.079; Federal Council explanations). Income-based premiums were no longer part of the proposal. Geneva (57.4 % yes), Vaud (56.2 %), Neuchâtel (60.4 %) and Jura (63.0 %) voted in favour.

The arguments as put forward by those involved in 2014

The Federal Council and Parliament recommended rejection. In their view, insured persons would no longer have had a choice, competition between insurers would have disappeared, the system with several insurers had proven itself in principle, and the restructuring would have involved uncertainties and costs that were hard to estimate. Supporters, backed by left-wing and green circles and consumer organisations, argued that a public fund would end the hunt for good risks and save marketing costs; they expected a simpler and cheaper system (Curia Vista 13.079). We report the positions without judging them.

Cantonal single funds in the Federal Parliament

After 2014, the debate shifted to the cantons. Because the KVG does not provide for a compulsory cantonal fund, three French-speaking cantons asked for a legal basis for one through cantonal initiatives. Parliament did not follow up any of them.

According to the Parliamentary Services, the preparatory committee of the Council of States doubted that cantonal single funds would bring substantial savings and feared major administrative difficulties and coordination problems if some cantons created a single fund and others kept the current system. The Geneva initiative justified its request partly with the premium increase of over 9 % for 2024 and with criticism of the large number of private insurers.

Status in Geneva: “réseau santé” and “caisse santé Genève”

Geneva is pursuing the issue further at cantonal level. On 30.12.2024, an expert group chaired by David Hiler unanimously adopted a report on creating a public health insurance fund in Geneva; the Council of State took note of it on 15.01.2025.

On 23.09.2026, the Council of State announced that, following the expert report, a feasibility study and an examination of implementation and financing, it was launching two calls for tender. One seeks an operator for a health network (“réseau santé”), the other a partner with the necessary actuarial expertise. The results are to allow the Council of State to decide whether to continue the project. The aim is better coordination between the players in the healthcare system and a slowdown in premiums; in the long term, the Council of State names a cantonal average premium that is 20 % lower.

In its announcement, the Council of State justifies the project with figures for the canton: premiums in Geneva have more than doubled since 1999, over 200,000 people or 38 % of the population receive a premium subsidy, and 26 % of the population say they forgo treatment for financial reasons, compared with 16 % in 2011.

The announcement of 23.09.2026 names neither a legal form nor a start date and does not say who could take out insurance with the “caisse santé”. A compulsory fund for all residents of Geneva is not possible without a change in federal law; Parliament rejected the corresponding Geneva cantonal initiative in 2025.

Status in Vaud: motion in the Grand Council

In the Grand Council of Vaud, member Sylvie Podio and co-signatories submitted motion 26_MOT_45 on behalf of the Greens: “Pour une caisse publique cantonale ou intercantonale au service de la santé de la population et de la maîtrise durable des coûts” (for a cantonal or intercantonal public fund serving the health of the population and the sustainable control of costs). It asks the Council of State to draw up the legal basis for a public, non-profit cantonal or intercantonal health insurance fund, combined with integrated care models, reinvestment of administrative savings in prevention and a governance structure in which insured persons, patients, professionals and authorities are represented.

At the session of 18.08.2026, the motion, signed by at least 20 members, was referred to a committee for examination. As of 25.09.2026, the Grand Council has not decided on it. Vaud’s earlier cantonal initiative 21.322 for a compulsory cantonal institution failed in the Federal Parliament in 2024.

Example: what the choice means for a budget today

Example with fictitious people. Nadia, 36, lives in the city of Geneva and has a CHF 300 deductible with accident cover. She compares the 2026 premiums from the table above.

In a system with a single fund per canton, this choice would not exist; under the 2014 initiative, there would have been a uniform premium per canton. How high it would have been cannot be derived from today’s figures, because administrative costs, reserves and models would be organised differently.

What does this mean for you?

As of 25.09.2026, nothing changes for your basic health insurance. You can still choose freely among all licensed insurers, the benefits are the same at all of them, and the premiums differ. Three points matter in practice:

1. Comparing pays off. As long as there are several insurers, you determine your premium by your choice of insurer, deductible and model. The premium calculator shows all offers in your municipality with the FOPH premiums.
2. You can switch every year. Your notice of cancellation for basic health insurance must reach your insurer by 30 November. You will find the procedure and deadlines under Switching health insurer.
3. Insurers differ in service and finances. The health insurer profiles show key figures on reserves, administrative costs and contact details.

If a canton were to offer its own fund alongside the existing ones in future, it would be a further option with its own premiums. Whether and when this will happen is open.

Common mistakes

• Confusing a single fund with a uniform premium. The uniform premium per insurer, region, age group and deductible already exists; a single fund does not.
• Assuming Geneva already has a public fund. As of 25.09.2026, calls for tender are under way; the Council of State will then decide whether to continue.
• Equating cantonal projects with a compulsory fund. A compulsory fund for all residents of a canton requires a change in federal law; Parliament has so far rejected this.
• Including supplementary insurance. All proposals concerned only basic health insurance.
• Not switching because of the debate. Today’s differences in premium apply to the current year, regardless of future reforms.

Another reform the Confederation is pushing ahead concerns data rather than insurers: the electronic health record. You will find more basics on basic health insurance in the topic area Understanding basic insurance. We explain how we present premiums under How we calculate.