Paying family carers requires a fit-for-purpose instrument: Lessons from Switzerland

Switzerland has recently expanded financial support for family caregiving not through a dedicated carer allowance, but by routing payments through professional home care reimbursement. Following Federal Supreme Court rulings, relatives without nursing qualifications can be paid for reimbursable nursing tasks when contracted through an authorised home care provider. Market entry by for-profit agencies, combined with fee-for-service billing and substantial municipal residual cost financing, has contributed to rapid growth in billed home care hours and has exposed monitoring and accountability gaps. The first implementation package of the Nursing Care Initiative further reduced administrative barriers by allowing nurses to initiate and bill selected services without a physician order, shifting authorisation closer to the billing entity. The Swiss case highlights a design risk relevant beyond Switzerland: using unmodified professional reimbursement mechanisms to remunerate family carers imports volume incentives and can enable rent extraction unless task definitions, tariffs, transparency, and oversight are adapted. Policy options include a distinct reimbursement pathway for lay family carers, tighter operational definitions, claim identifiers to enable monitoring, and financing levers that protect carer pay while limiting agency margins.