01.02.2010 The Federal Law on Prevention and Health Promotion
The main facts in brief. The aim of the Prevention Law (Präventionsgesetz) is to improve the management of prevention, health promotion and early detection measures in Switzerland. The Law also contains plans for a new federal-level centre of excellence, the Swiss Institute for Prevention and Health Promotion.
The draft law implements the legislative mandate enshrined in the Federal Constitution whereby the federal government is responsible not only for combating contagious diseases, but also for enacting regulations aimed at preventing pervasive or malignant non-contagious diseases. The Prevention Law will allow the government to expand its field of action in future to include work on the prevention and early detection of those chronic diseases which are of key importance in terms of both public health and trends in healthcare costs (e.g. cancer, diabetes, cardiovascular diseases or depression). The Law will have no impact on current regulations on the assumption of costs for preventive healthcare services and early detection measures covered by the mandatory health insurance system.
Setting priorities through control and coordination instruments
Thanks to new control and coordination instruments, government activities in the fields of prevention, health promotion and early detection will concentrate on those issues classed as significant by the federal government, cantons and private parties. On the one hand, national goals will be formulated every eight years. On the other, every four years the Federal Council will set out details of its strategic targets for the national programmes and for the planned Institute for Prevention and Health Promotion, as well as for the usage of revenues from prevention-related taxes (the additional premium specified by the Health Insurance Law (KVG) and the tobacco control tax). No specific priorities will be set at legislative level; instead, there will simply be a definition of how the control and coordination instruments should be developed and deployed. Particular attention will be paid to involving the cantons and private parties in the formulation of the national targets and the Federal Council’s strategy.
As before, government implementation measures will be packaged in the form of themed national programmes. These programmes will be developed and implemented by the Institute, in consultation with the cantons and any private stakeholders and business groups affected by the issue.
Clarification of division of tasks between federal government and cantons
The cantons will continue to hold primary responsibility for the implementation of prevention, health promotion and early detection measures. The draft law envisages that the federal government will only take action in areas where a coordinated nationwide approach would be practical or essential. This applies in particular to
– The planning and execution of measures with nationwide significance within the framework of national programmes;
– Information activities, especially in the form of campaigns;
– Financial aid to non-governmental organisations with a nationwide sphere of operations;
– Measures to support research, education and training;
– Further development of health statistics and reporting frameworks and harmonisation of data collection systems through diagnostic registers;
– International cooperation.
At the same time, the federal government will in future provide improved methodological and specialist support to the cantons (as well as to private prevention and health organisations) in the conception and execution of prevention, health promotion and early detection measures. The intention here is also to promote knowledge transfer of best practice models and effectiveness analyses as well as the development of new intervention models.
Financing principles and use of prevention taxes
The draft prevention law is based on the following financing principle: each level of government (federal and cantonal) is responsible for financing those functions that fall within its jurisdiction. In other words, federal functions must be financed from the ordinary federal budget, while the cantons are responsible for financing cantonal prevention, health promotion and early detection measures and the associated required facilities.
The funds provided by the KVG premium and the tobacco control tax will be made available primarily to the cantons and to private organisations for the (co)financing of their activities. The KVG premium currently stands at CHF 2.40 per insured person and year and generates revenue of approx. CHF 18 million per year. The tobacco control tax yields around CHF 16 million a year. As requested during the consultation phase, the draft law now also provides for a portion of these revenues to be set aside for contributions to cantonal programmes.
New federal-level centre of excellence
The draft law contains a proposal for the creation of a Swiss Institute for Prevention and Health Promotion. As a decentralised federal government body (public sector institution), this Institute is to be responsible for the following functions:
– Planning, implementing and evaluating national programmes;
– Developing information materials and implementing campaigns;
– Providing specialist and methodological support services;
– Administering prevention taxes.
This will make the Institute the central point of contact for both the cantons and private stakeholders for all questions relating to prevention, health promotion and early detection. The creation of an autonomous centre of excellence at federal level is intended to contribute to the process of embedding these issues firmly within Swiss health policy.
The cantons will have the right to propose three members of the nine-member governing council of the Institute, and the insurance companies one member. In addition to those organisational units of the Federal Office of Public Health (FOPH) which are already responsible for national programmes and for additional prevention, health promotion and early detection activities, the «Tobacco Prevention Fund» will also be transferred over to the Institute. This specialised entity administers the tobacco control tax and is currently affiliated with the FOPH.
The Swiss Foundation for Health Promotion, a foundation under private law created in 1996 on the basis of the Health Insurance Law (KVG), will also be affected by the implementation of the Prevention Law. With the proposed removal of Article 19 of the KVG, there will no longer be a legal mandate to health insurers to promote disease prevention and to run an institution for this purpose in partnership with the cantons. According to its Deed of Foundation, the Swiss Foundation for Health Promotion must cease operations if its legal mandate is withdrawn. However, the Prevention Law contains a provision allowing the Foundation to make an agreement with the Federal Council integrating it into the Institute for Prevention and Health Promotion.
Salome von Greyerz, Co-Head of Division Multisectoral Projects, Head of Section Innovation Projects, Federal Office of Public Health; email@example.com