Voters have thrown out a proposal on introducing a single health insurance company in Switzerland, and premiums based on income and wealth.
Offical results show more than 70 per cent of the electorate rejecting the reform.
The results showed just two of the country's 26 cantons had approved the reform. Turnout was above average, at 45.5 per cent.
As anticipated voters in the main German-speaking part of the country overwhelmingly rejected the plan, which was supported by the centre-left but opposed by the centre-right as well as the business community, parliament and the government.
Two French-speaking cantons, where health premiums are traditionally high, voted in favour, while the Italian-speaking canton voted against.
The proposal was the latest in a series of attempts to cut costs, notably health premiums.
There are currently 87 private insurers providing mandatory coverage for basic health care for residents in Switzerland under a 1996 law. But health premiums have soared spectacularly over the past decade.
More than 100,000 people are no longer covered because they haven't paid their premiums.
The centre-left Social Democrats and the Greens said a single health insurance scheme would boost the efficiency of the system and allow annual savings of at least SFr300 million ($245 million) in administrative costs.
They argued the current funding system is unbalanced, since many clients – about 20 per cent - claim state subsidies to pay for the premiums.
But opponents said a single insurance system would lead to complacency and create a two-tier system, where only the wealthy can afford to take out additional private insurance coverage.
They dismissed claims that the initiative could help bring down rising health expenditure.
Rein in costs
The proposal to merge the insurance companies and introduce premiums based on wealth and income is the latest in a series of attempts over the past ten years to rein in spending on health care.
Switzerland has the most expensive health system in Europe, according to an international comparison. It spent 11.6 per cent on health in 2005, ahead of Germany and France, but behind the United States.
There was uncertainty ahead of Sunday's ballot to what extent the middle class would benefit – or lose out – under the proposed single insurance plan. Proponents appeared to disagree on how to plug an expected shortfall in financial contributions from people taking out insurance.
In 2005 Switzerland spent SFr52.9 billion ($43.2 billion) or 11.6% of GDP.
The average for OECD countries is 8.8%.
The US spends 15.3%, Germany 10.9% and France 10.5% on health.
From 2001 health costs rose on average 4.1% a year in Switzerland.
The people's initiative for a single health insurance company and premiums based on income and wealth was launched by a family association in western Switzerland.
The proposal has the support of the political left, some trade unions and doctors' associations.
Parties from the centre-right, the right, the business community, government and parliament as well as the health insurers have come out against.
The proposal is an amendment to the Swiss constitution and needs a majority of voters and cantons to pass at the ballot box.
In compliance with the JTI standards