Doctors Again Demand Health Insurer Reserve Reduction
High reserves could curb premiums in the short term. But how much leeway do health insurers actually have?
The debate over health insurance reserves regularly resurfaces. As soon as new premium increases are imminent, the same question arises: Why should policyholders pay more when health insurers simultaneously have billions in reserves?
At the beginning of 2026, Swiss health insurers held approximately 8.6 billion Swiss francs in reserves. This is according to the 2025 annual financial statements published by the Federal Office of Public Health (FOPH). Last year, insurers generated an overall surplus of nearly 569 million francs, which flowed entirely into reserves. A large portion of this came from capital investments.
For the medical profession, this is an argument to use reserves more effectively to curb premiums. Insurers, in turn, warn against reducing the financial buffer too much. Both positions have a valid core.
Why do health insurers need reserves at all?
Reserves are not simply money a health insurer can freely distribute. They serve to ensure the insurer's solvency. If healthcare costs rise unexpectedly sharply, capital markets decline, or other financial burdens occur, reserves are intended to prevent an insurer from being unable to finance its services.
The Health Insurance Supervision Act therefore obliges insurers to maintain adequate reserves. The legal requirements aim to protect the financial security of health insurers and, ultimately, the interests of policyholders.
At the same time, there is an important limit: Reserves should not be excessively high. Premiums, according to legal rules, must also not lead to the accumulation of unnecessarily high reserves.
8.6 billion Swiss francs – but not freely available
The figure of 8.6 billion Swiss francs initially sounds enormous. However, it must be put into perspective with the entire insurance business. Reserves are not only meant to absorb short-term fluctuations but also to ensure the financial stability of health insurers.
Therefore, the absolute sum alone is not decisive. What is important is how high the reserves are in relation to the legal minimum requirement and the risk of the respective insurer.
The FOPH's KVG Solvency Test precisely measures this financial security. For the overall market, the solvency ratio in 2025 was 147 percent. This key figure simply means that the existing reserves were above the minimum level required by supervisory law. However, this does not mean that 47 percent of the reserves are automatically available for premium discounts.
Doctors want to use the buffer more
The demand for a reserve reduction is currently coming again from the medical profession. The Société médicale de la Suisse romande argues that reserves should more strongly fulfil their function as an “amortisseur” – i.e., a buffer – and that not every cost development should be immediately passed on to premium payers.
The medical association refers to developments in recent years. Between 2019 and 2022, insurers significantly reduced their reserves in some cases. In contrast, no voluntary reserve reduction occurred between 2023 and 2025.
According to the Western Swiss medical community, the current financial situation therefore suggests a stronger reliance on this buffer again. They anticipate a rather moderate premium increase of about 2 to 2.5 percent for 2027 and consider higher increases unjustified based on current cost data.
The FOPH already permits reserve reductions today
An important point is often overlooked in the public debate: Insurers are already permitted to strategically reduce their reserves.
The FOPH has provided various instruments for this. For example, insurers can calculate their premiums tightly or consider capital income when calculating premiums. Under certain conditions, a voluntary reduction of reserves is also possible.
With a voluntary reserve reduction, an insurer can use a portion of the reserves directly to benefit policyholders. However, this instrument is subject to conditions and must not jeopardize the financial security of the insurer.
The development shows that this possibility is not merely theoretical: In 2021, 14 insurers announced a voluntary reserve reduction. In 2024 and 2025, however, no insurer submitted such a reduction plan.
Why reserves cannot simply be distributed
This is precisely the core of the conflict. If insurers significantly reduced their reserves, they could lower premiums more sharply in the short term. At the same time, they would then have a smaller financial buffer for unexpected developments.
The FOPH therefore points out that adequate reserves are important for solvency. If financial security falls too low, insurers must rebuild their reserves later. This usually happens through premium income.
A reserve reduction is therefore not a permanent solution for rising healthcare costs. It can reduce the burden on policyholders for a certain period but does not address the root cause of cost development.
What would a reserve reduction mean for premiums?
The answer cannot be given with a single figure. How much a reserve reduction influences premiums depends, among other things, on the financial situation of the respective insurer and the development of its costs.
Individual health insurers also differ significantly. An insurer with high reserves and stable solvency generally has more leeway than an insurer closer to the supervisory minimum level.
Therefore, a general access to reserves would not automatically lead to the same premium relief for all policyholders.
The problem is not just with reserves
Premium development ultimately depends on healthcare costs. If more medical services are utilized, treatments become more expensive, or tariff structures change, the costs of compulsory health care insurance rise.
This is precisely why health policy is increasingly focusing on cost-containment measures. The federal government is working, among other things, with cost targets, tariff reforms, and other instruments to curb the growth of healthcare expenditures.
The Federal Council also enacted an indirect counter-proposal to the cost brake initiative on January 1, 2026. By the end of 2026, targets for maximum cost growth for the years 2028 to 2031 are to be set for the first time.
This shows: The long-term premium question cannot be solved by reserves alone. What remains crucial is how healthcare costs develop and which services are financed at what prices.
Why the discussion is still important
The dispute over reserves is therefore more than a disagreement about billions. It touches on a fundamental question of the Swiss healthcare system: How large must the financial safety net of health insurers be?
If the buffer is too small, the risk increases that an insurer will face financial pressure from unexpectedly high costs. Conversely, if it is permanently very large, the question arises whether policyholders are paying unnecessarily high premiums.
Today's system attempts to mediate between these two risks. Supervision prescribes minimum reserves but also allows instruments for reducing excessive reserves when solvency is adequate.
The real dispute: How much reserve is enough?
This is precisely where interests collide. The medical profession wants to use the financial buffer more to relieve premium payers. Insurers must simultaneously ensure they remain solvent even with unexpected cost increases.
The current figures show neither that health insurers could distribute their reserves arbitrarily, nor that a reserve reduction would be fundamentally impossible. Both are part of the existing system.
The decisive question is therefore not whether reserves may be reduced. That is already possible. Rather, the crucial question is how much financial buffer is actually necessary and what portion beyond that can be used for premium relief.
For policyholders, a reserve reduction would be attractive in the short term. However, premiums would not automatically fall sustainably as a result. For that, the growth of healthcare costs would primarily need to be curbed.
The billions in reserves are therefore neither an untouchable treasure of health insurers nor freely available funds for policyholders. They are primarily a safety mechanism – and the political debate is likely to continue over precisely how large this safety mechanism needs to be.
Sources
- Federal Office of Public Health (FOPH): 2025 Annual Financial Statements of Health Insurers
- Federal Office of Public Health (FOPH): Instruments for Reserve Reduction
- Federal Office of Public Health (FOPH): KVG Solvency Test
- Federal Office of Public Health (FOPH): Health Insurance Supervision Act (KVAG)
- Société médicale de la Suisse romande: «Les réserves des caisses maladie devraient jouer leur rôle d’amortisseur», September 2026
