Fiscal federalism and income redistribution through healthcare financing : an empirical analysis for the Swiss cantons

Previous studies have viewed Swiss health-care financing as particularly regressive. However, as the OECD Review of the Swiss Health System (2011) stated, the income-related inequities and the inter cantonal variations are still unexplored due to a lack of available information. The present paper aims to fill this information gap concerning the Swiss health system by exploring the differences in the level of regressivity of health-care system financing across cantons and over time using household data. The empirical evidence confirms that the Swiss health-care system financing has remained quite regressive since the major reform of 1996 and that the variations in equity across cantons are quite significant. The results are an interesting contribution towards re-thinking a new possible reform of the Swiss health-care system, as well as for other federal states (such as the U.S.) that use regulation and subsidies to ensure universal coverage.