EFAS

What is EFAS?

EFAS is the German abbreviation for “einheitliche Finanzierung ambulant und stationär”, the uniform financing of outpatient and inpatient services. It refers to an amendment to the Federal Health Insurance Act (KVG) that governs who pays for the services covered by basic health insurance. Today, that depends on where you are treated. With EFAS, the same key for splitting costs between the cantons and premium payers will apply to all services from 2028.

To understand EFAS, you need to know how things work today. If you are treated as an inpatient, i.e. with at least one night in hospital, your canton of residence pays at least 55% of the hospital’s remuneration and your health insurer pays the rest. If you are treated as an outpatient, i.e. without an overnight stay, the health insurer pays everything, and therefore so do the premium payers. For care at home and in nursing homes, the health insurer and the person in need of care each pay a contribution, and the canton finances the rest.

This split has a side effect. Many procedures that used to require an overnight stay in hospital can now be carried out on an outpatient basis. That is usually cheaper. But because the costs are then paid entirely through premiums, the share financed by premiums rises, even though the system as a whole saves money. According to the Federal Office of Public Health (FOPH), premiums have therefore risen faster than the total cost of services under the KVG. In addition, health insurers had little financial incentive to promote the shift towards outpatient before inpatient.

This is where EFAS comes in: from 2028, health insurers will reimburse all services, outpatient and inpatient alike, and the cantons will contribute a fixed share of the total costs. EFAS is not a new insurance and not a new product. Nothing changes regarding the services you receive.

How it works

The new cost-sharing key

From 01.01.2028, the cantons will pay the insurers a contribution of 26.9% of net costs. Net costs are the costs after deduction of the co-payment, i.e. after the deductible (Franchise) and retention fee (Selbstbehalt). The remaining 73.1% will be financed through premiums. The key applies equally to outpatient and inpatient services.

Area	until 31.12.2027	from 01.01.2028	from 01.01.2032
Inpatient (listed hospital)	canton at least 55%, premiums at most 45%	canton 26.9%, premiums 73.1%	as in 2028
Outpatient	premiums 100%	canton 26.9%, premiums 73.1%	as in 2028
Care at home and in nursing homes	contributions from health insurer and person in need of care, residual financing by canton	unchanged	financed uniformly, contribution from person in need of care remains

The flow of money

The health insurer pays the service providers’ bills under the tiers payant system, or reimburses you under the tiers garant system, just as it does today. The cantonal contributions are calculated by a specialised committee of the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG) on the basis of the services provided; it collects them from the cantons and distributes them among the insurers. The cantons are represented on this committee so that they can check how their tax revenue is distributed.

New roles for the cantons

Because the cantons will now also co-finance outpatient services, they will gain more scope for steering. They will now be represented in the tariff organisation for outpatient medical services. They can impose a freeze on admissions for all categories of outpatient service providers if costs in a canton rise faster than average. And they will receive data from the insurers for their tasks under the KVG. Checking whether a service is effective, appropriate and cost-effective in an individual case remains the responsibility of the health insurers.

Long-term care from 2032

From 01.01.2032, care services at home and in nursing homes will also be financed uniformly. People in need of care will continue to pay a contribution, the amount of which is set by the Federal Council. It must set the contribution so that it is no higher after the switch than before, and may not increase it for at least four years. In future, care services will be reimbursed through tariffs, for which a new tariff organisation made up of service providers, insurers and cantons will be responsible. You can find more about the current rules under the term financing of long-term care.

Legal basis

EFAS is based on an amendment to the KVG that Parliament adopted in the final vote on 22.12.2023. It goes back to parliamentary initiative 09.528 “Financing of healthcare services from a single source. Introduction of monism”. A referendum was launched against the amendment; in the popular vote of 24.11.2024, it was approved with 53.31% in favour. The new provisions are not yet in force. According to the FOPH, the ordinance amendments are due to come into force on 01.01.2028.

Until then, current law applies. Art. 49a para. 1 KVG stipulates that the canton and the insurer each pay a share of the remuneration for inpatient services. Under Art. 49a para. 2ter KVG, each canton sets its share annually, no later than nine months before the start of the calendar year; it must be at least 55%. For care services, basic health insurance pays a contribution under Art. 25a KVG, and the cantons regulate the residual financing.

As soon as the EFAS provisions are in force, they will appear in the consolidated version of the KVG on fedlex.admin.ch. We will then update this page with the new article numbers.

Example: same procedure, different financing

A procedure can be carried out on an inpatient or outpatient basis. The amounts are assumed treatment costs; the shares are taken from the law (today) and from FOPH information (from 2028). The co-payment has not been deducted here, to keep the comparison clear.

Option	Costs	Canton today	Premiums today	Canton from 2028	Premiums from 2028
Inpatient	CHF 10,000	CHF 5,500	CHF 4,500	CHF 2,690	CHF 7,310
Outpatient	CHF 6,000	CHF 0	CHF 6,000	CHF 1,614	CHF 4,386

The calculation shows the principle, not your future premium. How premiums develop from 2028 depends on overall cost trends. You can find the current 2026 premiums for your municipality in the premium calculator.

What this means for you

In the short term, you do not need to do anything because of EFAS. The reform mainly concerns financing between the cantons and health insurers. These points are nevertheless worth knowing:

1. Your benefits stay the same. EFAS changes neither the list of benefits nor your free choice of health insurer. Whether you receive treatment as an outpatient or inpatient will continue to be decided on medical grounds.
2. Choosing your health insurer remains important. The premium differences between insurers remain. Compare every autumn and use the deadline of 30 November; all dates are listed under deadlines, and the insurer profiles under health insurers.
3. Watch for news on implementation. Ordinances and tariffs will be adjusted by 2028. You can find new developments under news.
4. Keep long-term care in mind. If you have relatives in a nursing home or receiving home care (Spitex), the second stage from 2032 is what mainly affects you. The contribution paid by people in need of care may not increase with the switch.
5. Check premium subsidies. Independently of EFAS, the cantons help people on low incomes with premium subsidies.

Common mistakes

• Thinking EFAS is a new insurance. EFAS is a financing reform. You do not need to take anything out or cancel anything.
• Believing EFAS already applies. Until 31.12.2027, the current split applies, with a cantonal share of at least 55% for hospital stays.
• Expecting premiums to fall. The fixed cantonal share slows the shift of costs onto premiums, but it does not guarantee lower premiums.
• Forgetting long-term care. Care services will only be included from 01.01.2032, not as early as 2028.

We explain how we handle figures and sources under how we calculate.