What should health cost?
On 16 November 2024, a national Citizens' Assemblyl on the topic of ‘rising healthcare costs’ began in Switzerland. 100 randomly selected residents from all over the country are taking part. The mini-public is also a research project on the question of whether and how citizens' assemblies can enrich democratic debates and create space for differentiated discussions.
‘The quality of public debates and democratic dialogue are under pressure. Increasing polarisation and changing media habits are making it more difficult to create a common understanding of key challenges within society and to hold respectful and solution-oriented discussions without ideological blinkers,‘ says the website of the Citizens’ Assembly, which is run by the Universities of Geneva and Zurich.
Counteracting challenges
One of the aims of the ‘Citizens' Assembly 2025’ project is to analyse the extent to which new forms of democracy can counteract these challenges. The focus is on the question of the extent to which mini-publics are suitable for conducting important social debates, promoting understanding of different points of view and thus contributing to a constructive and diverse public debate.
In order to investigate these questions, this research project will also analyse the extent to which the results of the citizens‘ assembly contribute to the opinion-forming of people who were not themselves part of the discussions in the assembly.
Healthcare costs are a particularly pressing issue
In April 2024, 22,000 people from all over Switzerland were invited by letter to take part in the Citizens' Assembly. All those invited were able to choose one of five proposed topics. More than 40 per cent of respondents opted for the topic of ‘rising healthcare costs’ - ahead of energy supply, neutrality policy, pension funding and European policy.
The most common reason given by respondents for their choice of topic was the increasing financial burden on households, which is becoming unbearable for a large proportion of the population. Many also saw the Citizens' Assembly as an opportunity to conduct a solution-orientated discussion without the influence of interest groups and to provide new impetus. The extent to which the population is affected also plays an important role:
Discussion about healthcare
In Switzerland, there are discussions about whether a healthcare system that emphasises personal responsibility should be pursued or one that places greater emphasis on solidarity between the sick and the healthy. There are also differing opinions on how competences should be divided between the federal government and the cantons. Another issue is whether the Swiss want a healthcare system that is more cost-orientated or one that focuses more on the quality of services.
‘The Citizens' Assembly will not be able to solve the challenges in the healthcare system conclusively,’ it says on its website. Rather, the mini-public creates a space in which a diverse representation of the population can negotiate these conflicting goals together and contribute to the discussion on possible reforms in the healthcare system.
22,000 people invited
Around 22,000 people over the age of 16, regardless of their citizenship, were randomly selected from the Federal Statistical Office's register and invited in writing to take part in the Citizens' Assembly. 2,004 interested people applied to take part.
When compiling the mini-public from these applications, age, gender, place of residence (city, rural area or something in between as well as the region), highest level of education and political views of the applicants were taken into account. The ‘Voting frequency’ category was used to record how regularly the registered persons take part in elections and referendums and the results were taken into account accordingly when compiling the group. According to these criteria, the Citizens' Assembly is an approximate reflection of the population.
Three weekends, four online meetings
The assembly participants meet on three weekends in Zurich, Neuchâtel and Bern. Four online meetings are also held. In the first phase, the 100 participants find out more about the topic of ‘rising healthcare costs’ and decide which focus they want to work on. In the second phase, they share their opinions with each other and discuss with politicians. At the end, they prepare the findings and proposals in a final report for the public and politicians.