Zurich introduces free basic healthcare for undocumented residents

Zurich has become the first city in German-speaking Switzerland to introduce free basic medical care for people without health insurance, including undocumented residents known as sans-papiers. The city parliament approved CHF 1.9 million in annual funding, turning a pilot project into a permanent public service.

The decision marks a significant shift in municipal health policy and has reignited political debate over solidarity, cost-sharing, and fears that generous social services could attract vulnerable populations to the city.

From pilot project to permanent service

The healthcare program has been running as a pilot project since 2022, funded by the city of Zurich. Until now, uninsured individuals could usually only access medical treatment in emergencies. Under the new arrangement, they will also receive care for chronic conditions such as diabetes, high blood pressure, or long-term infections.

With a vote of 86 to 33, the city parliament approved making the program permanent. According to city estimates, the service will benefit between 11,000 and 14,000 people living in Zurich without valid health insurance.

Political divide over responsibility and incentives

While the pilot project initially enjoyed cross-party backing, opposition has grown. The Free Democratic Party (FDP), which supported the trial phase five years ago, voted against the permanent rollout. FDP councillor Deborah Wettstein criticized the city for acting unilaterally.

She argued that Zurich had failed to properly clarify whether responsibility lies with the federal government or the canton, and questioned why undocumented people in Zurich should receive better access to healthcare than those elsewhere in the canton.

The Swiss People’s Party (SVP) also opposed the move, warning that free healthcare could act as a pull factor, encouraging uninsured people to move to Zurich.

Supporters stress dignity and cost savings

Backers of the policy strongly rejected these concerns. Representatives from the Social Democrats (SP), Greens, and Alternative Left (AL) pointed to the five-year pilot phase, during which no evidence emerged that Zurich attracted additional uninsured residents because of the program.

They argued that early access to healthcare reduces long-term costs, as patients are treated before conditions escalate into emergencies that burden hospitals and emergency services.

“It’s about human dignity,” said SP councillor Nadina Diday. “The dignity of people who live in this city — and our obligation to act in solidarity.”

Pressure on the canton

The Centre Party and the Green Liberals (GLP) also supported the measure, citing the canton of Zurich’s refusal to provide a comparable basic healthcare solution for the most vulnerable groups. Several speakers urged the city to push the canton to contribute financially to the CHF 1.9 million annual cost.

A majority of the city parliament agreed, signaling that Zurich may seek cantonal cost-sharing in the future.

A precedent for other cities?

With the vote, Zurich sets a precedent in German-speaking Switzerland. While similar models exist in parts of French-speaking Switzerland, the decision could intensify national debate about how far municipalities should go in compensating for gaps in the federal health insurance system.

For now, Zurich’s free basic healthcare program will move forward — framed by supporters as a pragmatic and humane solution, and by critics as a risky step that blurs political responsibilities.