How Switzerland assesses and funds long-term care: LAMal, the cantons, and RAI

LAMal (Loi sur l’assurance-maladie, the Swiss federal health-insurance law, known as KVG in German) is the statute that makes health insurance compulsory in Switzerland and, since 2011, sets how long-term and home care is funded — through a three-payer split between the health insurer, the resident, and the canton.

Switzerland runs one of Europe’s more expensive long-term-care systems without a single national assessment instrument. There is no Swiss BelRAI. Federal law (LAMal) sets the financing rules. The 26 cantons fill in most of the details: which assessment tool is used, the tariffs, how much the resident pays, and who covers the rest.

If you build or run software for a Spitex (home-care) organisation or an EMS (nursing home), that split is the first thing to understand. The mechanics are federal, but the details that break an integration are cantonal. This guide covers how care is funded, how care needs become money, which instruments are actually in use, and why the canton keeps mattering.

How care is funded: the LAMal three-payer model

Since 2011, long-term care in Switzerland has been paid for under article 25a of the LAMal (the federal health-insurance law), which splits the care cost three ways (the Federal Office of Public Health describes the same three payers here):

• The health insurer pays a fixed contribution: a set number of francs tied to the assessed level of care, not a percentage of the bill. These amounts are defined federally, in the OPAS.
• The resident pays a contribution capped by federal law at no more than 20% of the highest insurer contribution. In practice, that means a maximum of about CHF 15.35 per day for home care and CHF 23.00 per day in a nursing home. Cantons may set it lower (Geneva and Valais, for instance, cap it near CHF 10/day; some waive it).
• The canton or commune covers everything left over: the financement résiduel (Restfinanzierung). This is the largest and most variable share, and it is governed by the canton where the provider is based.

One important line: only care (soins/Pflege) is split this way. Board and lodging in an EMS, and non-medical accompaniment, are paid by the resident, with means-tested help (prestations complémentaires) where needed. So “who pays for the nursing home” is really two questions, and only one runs through LAMal.

From care minutes to francs: OPAS article 7

The bridge between an assessment and a bill is OPAS article 7, which defines the three kinds of care that can be charged to LAMal: (a) assessment, advice and coordination; (b) examinations and treatments (skilled nursing); and (c) basic care (help with daily living).

How those convert to money depends on the setting. Home care (Spitex) is billed by the hour, per category, and the insurer’s contribution per hour is set nationally. At the time of writing, the rates are CHF 76.90 for category (a), CHF 63.00 for (b) and CHF 52.60 for (c), billed in five-minute units. Nursing homes (EMS) use a daily scale of twelve care levels in 20-minute bands: level 1 (up to 20 minutes of care a day) draws about CHF 9.60/day, and each band adds roughly CHF 9.60, up to about CHF 115.20/day at the top level (more than 220 minutes).

The assessment establishes how many minutes of care a person needs. That figure puts them on a level, and the level fixes the insurer’s contribution. Everything above it goes to the capped resident contribution and then to the canton. These francs are revised periodically, and a palliative-care uplift is due in 2027, so confirm the current amounts against the OPAS before you rely on them.

A worked home-care day

Take one day of Spitex basic care — OPAS category (c), billed at the national rate of CHF 52.60 per hour. Say the person receives two hours that day, so the care line comes to CHF 105.20. Here is how that single figure splits across the three payers:

• Insurer: the fixed national contribution for category (c), CHF 52.60 per hour, so CHF 105.20 for the two hours. This is the insurer’s whole share; it does not rise with the provider’s actual costs.
• Resident: their daily participation, capped by federal law at no more than CHF 15.35 per day for home care — and often lower, since many cantons set it below the federal cap (or waive it).
• Canton (residual financing): whatever the provider’s real cost of that care exceeds the insurer contribution plus the capped resident share. It is the balancing item, and its size depends entirely on the cantonal tariff.

The pattern is the point: the insurer contribution is fixed per hour and per category, the resident contribution is capped and cantonally variable, and the canton absorbs the residual. Your billing engine has to compute all three from the same assessment — and the resident cap and the residual rule both change the moment the provider is in a different canton.

The assessment instruments, and why there’s no single one

This is often the surprise for people coming from Belgium or the Netherlands: the choice of assessment instrument is cantonal and organisational, not federal. The Confederation recognises a family of tools; which one a provider uses is decided locally.

Three matter:

• RAI-HC, now interRAI HC Suisse: the interRAI-based home-care instrument published by the national Spitex association. By the end of 2021 the large majority of non-profit Spitex organisations had adopted it, and it dominates home care.
• BESA: a catalogue of care acts with reference times, strong in the German-speaking cantons and used in both nursing homes and some Spitex.
• PLAISIR: an older instrument still found in parts of French-speaking Switzerland, now being displaced.

For nursing homes the picture has historically been RAI-NH, BESA or PLAISIR depending on the canton. The sector body has decided to move EMS toward a single instrument, interRAI LTCF, over about five years, with BESA support ending in mid-2028. But “converging” is not “converged”. As of 2025-2026 the multi-instrument landscape is still live, and software that only speaks one of them is betting on a transition that has not finished.

Why the canton matters

Federal law sets the frame; the canton fills it in. The differences are not cosmetic. Cantons vary on residual-financing rules and rates, the accepted assessment instrument, the resident contribution within the federal cap, tariffs, and reporting. The resident’s daily contribution can be the full federal cap in one canton and roughly half of it in another. The care-cost taxes an EMS charges swing widely from one canton to the next. The language also changes with the region: German across most of the country, French in the west, Italian in Ticino. That is a product requirement, not a nicety.

The practical consequence: a Spitex or EMS product that works cleanly in Zürich does not automatically work in Vaud or Ticino. The billing split, the instrument, the tariffs and the reporting all have to be configurable per canton.

The reforms in motion (2024-2026)

Several federal changes are reshaping the financing frame, on timelines worth tracking:

• EFAS, uniform financing of outpatient and inpatient care, was accepted in a national referendum on 24 November 2024. It moves everything to a single funding key (cantons at least 26.9%, insurers the rest), with the general reform starting in 2028 and long-term care folded in later, from around 2032. For LTC it is a big structural shift: the canton stops being the residual payer of last resort and instead co-funds through the shared key.
• The nursing initiative (accepted in 2021) is being implemented in stages: a training-promotion law came into force in mid-2024, and a second stage on working conditions is now in Parliament.
• The electronic patient record is being reformed: nursing homes have been obliged to connect since 2022, and a new law adopted in late 2025 replaces the current dossier with a new electronic health record from around 2030.

What it means for your software

For a Swiss Spitex or EMS product, the assessment is only one layer. A serious system has to:

• support more than one assessment instrument, including interRAI HC for home care, interRAI LTCF or BESA for nursing homes, and residual PLAISIR, while handling the BESA-to-interRAI migration that finishes in 2028;
• map care minutes to money, either onto the twelve EMS levels or onto home-care hours priced by the three OPAS categories;
• run the three-way LAMal split correctly: insurer contribution, capped resident contribution (with the right home-care-vs-EMS cap), and canton residual financing, under the rules of the canton where the provider sits;
• carry per-canton tariffs and reporting, and a DE/FR/IT interface and documents;
• and stay ready for the next changes, including the electronic health record around 2030 and the EFAS financing change for long-term care from about 2032.

That is a lot of region-specific logic for one product to hold, and the rules keep changing. This is where off-the-shelf packages often struggle, and where a custom build or a clean integration can be worth it.

Frequently asked questions

Does Switzerland use BelRAI or a single national assessment tool?

No. There is no Swiss BelRAI and no single mandated instrument. Home care mostly uses interRAI HC Suisse; nursing homes use RAI-NH, BESA or PLAISIR depending on the canton. The sector is converging on interRAI LTCF for nursing homes by around 2028, but the choice is still cantonal and organisational today.

Who pays for long-term care under LAMal?

Three payers share the care cost: the health insurer pays a fixed contribution tied to the care level, the resident pays a contribution capped by federal law (about CHF 15.35/day at home, CHF 23.00/day in an EMS, sometimes less by canton), and the canton or commune covers the residual. Board, lodging and non-medical accompaniment are paid separately by the resident.

How do care needs turn into money?

An assessment establishes how many minutes of care a day someone needs. In a nursing home that places them on one of twelve levels (roughly CHF 9.60 to CHF 115.20 per day of insurer contribution); in home care the hours are priced by the three OPAS categories. The level or category fixes the insurer’s share; the rest goes to the capped resident contribution and the canton.

Does our software need to handle cantonal differences?

Yes. Residual financing, the accepted instrument, the resident contribution within the federal cap, tariffs and reporting all vary by canton. The interface also has to work in German, French and Italian. A product built for one canton rarely drops into another unchanged.

When the rules differ by canton, your software has to bend

Swiss care data has to be structured, billable and portable under one federal frame and 26 cantonal rulebooks. Instruments, tariffs, contributions and reporting still differ, and EFAS and the electronic health record will change the shape again. Off-the-shelf software can lag behind that kind of regional logic. When we built billing flows for a home-care team, the hard part was never the arithmetic of the three-payer split — it was keeping the resident cap and the residual rule configurable per canton so one deployment could serve providers in different regions. AppSky builds software for home-care and nursing teams, where assessment, care planning and billing sit in one flow and can follow the rules as they change. See what we did for Domihome, or book an intro call.

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This guide is informational and not billing, legal or medical advice. Swiss care financing is federal but heavily cantonal, and several reforms (EFAS, the nursing initiative, the electronic health record) are in transition. The OPAS francs are revised periodically. Confirm current rules and amounts with the official sources, including the Federal Office of Public Health, the law itself on Fedlex, and your cantonal health department. Last verified 12 July 2026.