The Family Doctor Model for Swiss Mandatory Health Insurance Explained

The family doctor model is the most widely used mandatory health insurance model in Switzerland. 

The role of a family doctor, also known as a general practitioner or a primary care physician, is to act as a gatekeeper. With the family doctor model, you do not choose which doctors or specialists you want to visit. Instead, you have to visit just one family doctor first, and they refer you to specialists, therapists, or hospitals, as they deem necessary.

If you choose to receive treatment from a specialist without being referred by your doctor, your health insurance policy will not cover the costs. There are a few exceptions to this rule. Medical emergencies, treatment by dental surgeons, eye specialists and gynecologists are covered even without a referral from your doctor. Along with the limitations, you receive a discount on premiums.

Premiums for a family doctor-based policy can work out more than 20 percent cheaper than standard insurance policy premiums. You receive exactly the same insurance coverage which you get with a standard obligatory insurance policy because benefits are dictated by law and are identical for all obligatory policies.

The family doctor model is the most popular savings option

Of the total of 39 Swiss health insurers, 35 offer the family doctor model in 2024. For reference: The telemedicine model is offered by just 31 insurers and only 16 insurance companies offer the HMO model. However, health insurers do not necessarily offer the family doctor model in all cantons.

Pharmacy-specific policies are the exception

Some insurers offer several different family doctor policies. For example, Assura lets you choose between a regular family doctor policy and the Assura Phar-Med option. The latter limits you to purchasing pharmaceuticals at partner pharmacies. In exchange, you pay lower insurance premiums. The Medpharm offer from Swica takes this approach a step further: Instead of visiting a family doctor as your first stop, you visit a pharmacy, and the pharmacist refers you to doctors or specialists as they deem necessary.

What should I know before changing to the family doctor model?

• Your health insurance provider may not have partnerships with all of the family doctors near you. If you want to use a specific general practitioner, make sure to check whether they are eligible before you sign up for an insurance offer. Many insurance companies provide a list of eligible family doctors that you can review before you get insured.
• Choose your family doctor carefully, as you will have to visit that doctor as a first stop every time you need medical care.
• If a health insurance company offers several variants of the family doctor model, make sure to check the exact terms and conditions of the policy carefully before signing up. The general rule is that the cheaper the health insurance offer is, the more limitations you will have to accept.

The advantages of the family doctor model

• You can profit from major savings on insurance premiums, depending on your insurer and policy.
• The obligation to visit your doctor first can actually be beneficial: Your doctor will often know your medical history and special needs better than a specialist. This can help you receive more effective treatment.
• Unlike the HMO model, the family doctor model is also widely available in more rural parts of the country. No matter which part of Switzerland you live in, your chances of finding a nearby family doctor are high.

The disadvantages of the family doctor model

• You are not free to make your own healthcare decisions: Even if you are absolutely certain that you need to be treated by a specialist, in most cases you cannot visit one directly. You will have to visit your family doctor first, and they will decide if you need to be referred to a specialist.
• Although the family doctor model is widely used, there is a chance that your insurance provider does not offer it. In that case, you will have to migrate to a different health insurance provider in order to use the family doctor model. Additionally, it is also possible that your preferred doctor will not be on an insurance company’s list of eligible family doctors.
• Your family doctor generally decides on which medical care you need. If you want to visit a different doctor to get a second opinion, the insurance generally will not cover that consultation.

More on this topic:
Swiss health insurance comparison
Swiss supplementary hospital insurance comparison
Swiss supplementary outpatient insurance comparison
HMO health insurance model explained
Telmed health insurance model explained