Emergency fee: Why the surcharge would also hit genuine emergencies
Since 2017 parliament has wrestled over 50 francs. The draft shows how hard it is to steer patients without making necessary help harder to get.
The 50 francs are meant to keep people with minor complaints away from hospital emergency departments. But the proposal parliament is arguing over no longer distinguishes between harmless and dangerous complaints. What would be decisive is the written referral, statutory exemptions and a deductible that has already been used up. It is precisely this shift that explains why a seemingly simple fee has still not found a majority in both chambers after almost nine years.
On 15 September the Council of States voted 33 to 11, with one abstention, against entering into the debate. The item now goes back to the National Council. It had approved the draft on 18 March 2026 by 96 votes to 91, with three abstentions. The additional emergency fee therefore remains a political proposal, not a payment obligation in force.
First an idea, then ever new hurdles
The impetus came from Green Liberal Party National Council member Thomas Weibel on 27 September 2017. He wanted a fee charged directly on the spot, of 50 francs for example, independent of the deductible and the co-payment. After he left parliament, his party colleague Martin Bäumle took over the initiative.
The official chronology does not show nine years of mere inaction but shifting majorities. The National Council gave the green light in 2019. The Council of States followed in 2021 on a motion by Jakob Stark (SVP/TG), against the position of its health committee. After hearings, the National Council's committee wanted to end the project in 2022; the council refused to drop it.
In 2023 the variant of a national fee failed in committee work because of constitutional and practical difficulties. What remained was the route via health insurance. In 2025 the committee adopted its draft by 13 votes to 12. The dispute therefore increasingly revolved around how the political demand could become an enforceable rule.
The referral replaces the diagnosis
Under the draft, cantons could introduce a surcharge of at most 50 francs per emergency consultation on top of the co-payment for people insured under compulsory health care insurance. Exempt would be, among others, minors, pregnant women and women up to eight weeks after giving birth, people brought in by transport or rescue services, and people with a written referral from a doctor's practice, a pharmacy, a telemedicine centre or a cantonal emergency number.
The model does not provide for a general exemption based on medical urgency alone. A genuine emergency would therefore not automatically be exempt from the surcharge. That is the decisive difference between the political catchword “trivial fee” and the instrument actually envisaged.
The committee report gives the reason: “trivial case” is defined neither in law nor in medical practice. Drawing the line case by case would create extra assessments and uncertainty. Doing without it simplifies the rule on paper but makes it less precisely targeted.
Why the deductible limits the incentive
There is a second restriction as well: the surcharge would only apply once the annual deductible has been reached. Before that, insured people pay their treatment costs themselves anyway. After that, the surcharge would fall due regardless of how much co-payment has already been paid.
The extra burden therefore also depends on previous health spending. People with high treatment costs could be caught more often than someone who rarely needs medical help. In the Council of States, Health Minister Elisabeth Baume-Schneider explicitly warned against burdening the seriously and chronically ill.
Cantonal freedom of choice would also have consequences beyond cantonal borders. The canton of residence of the insured person would be decisive, the federal councillor explained: anyone living in a canton with a surcharge would in principle also have to pay it for an emergency visit outside that canton. Insurers would accordingly have to distinguish.
Fewer visits are still no proof of better care
That emergency departments are under heavy strain is documented. The Obsan Bulletin 10/2024 records around 2.25 million outpatient admissions for 2022. The rate was twelve percent above that of 2019. These figures measure use, not the share of unnecessary treatments.
In the latest debate Stark argued that cantons should be allowed to test the price signal. He expects more personal responsibility and relief for staff. Damian Müller (FDP/LU), by contrast, pointed to the lack of alternatives at night, at weekends and in peripheral regions. Flavia Wasserfallen (SP/BE) doubted the evidence that this model would bring relief.
The insurers' association prio.swiss also rejects the draft: checking exemptions and cost-sharing as well as later invoice corrections would be costly. These are reasoned objections and expectations of effects, not already measured consequences of a fee introduced in Switzerland.
The National Council must now decide whether to stick with the project. The bigger question remains open: can a financial incentive relieve emergency departments when no reachable alternative exists? The quality of a solution will have to be measured by whether it reduces unnecessary visits without delaying necessary help.
Sources
- Swiss Parliament: item 17.480 and chronology
- Official Bulletin: Council of States debate and vote of 15 September 2026, provisional text
- SGK-N: committee report of 10 April 2025, Federal Gazette 2025 1705
- Obsan: outpatient consultations in emergency departments, Bulletin 10/2024
- prio.swiss: autumn 2026 session letter, position on item 17.480
- Starting point: Medinside of 15 September 2026
