[Health Democracy: a national or cantonal issue in Switzerland ?]

Western health systems are facing unprecedented challenges related to an aging population and climate issues. While the need for care will grow significantly, our societies will have to arbitrate the allocation of both, financial and human resources. Choices will have to be made, making it essential for citizens and patients to participate strongly. In Switzerland, a federal state renowned for its direct democracy, we can ask ourselves at what political level these health democracy issues are situated. Is it primarily the federal or cantonal level? This article discusses, based on the analysis of the distribution of health competences between the Confederation and the canton, the complexity of the governance of the Swiss health system and the opportunities to strengthen this health democracy.