Digitalization and Federalism: Is That Even Possible? – Simply Explained

clarus.news | Analysis in simple language | May 22, 2026

Switzerland wants to digitize its healthcare system. But the federal government and the cantons don't want the same thing. The federal government wants to keep foreign companies away. Some cantons are buying exactly these companies. We explain why this is a problem – and what could be done.

What is this about?

Healthcare generates a lot of data: diagnoses, medications, laboratory values. This data should be stored and exchanged digitally. This should make treatment better and safer.

That sounds simple. But in Switzerland it hasn't been working well for years. The reason is not the technology. The reason is responsibility: Who is allowed to decide?

The Federal Government and Cantons Want Different Things

Switzerland is a federal state. This means: There is the federal government (the government in Bern) and 26 cantons. In healthcare, mainly the cantons decide for themselves. Also regarding the computer system of hospitals.

Now something contradictory is happening:

The federal government is planning a large platform for health data. It's called "Health Data Space." The federal government doesn't want this data to reach US companies. The reason is a US law, the Cloud Act. This law forces US companies to hand over data to US authorities. This applies even when the data is located in Switzerland.

The Canton of Bern is doing the opposite. The Inselspital in Bern has been using US software since 2024. It's called Epic. It now costs 228 million francs. For comparison: 83 million were planned at the beginning. And the canton wants to mandate Epic for all its hospitals.

The problem: The federal government cannot prohibit this. Because the cantons are allowed to decide for themselves what they buy.

Two Projects That Belong Together

At the federal level there are two important projects. They are connected, but were separated.

The electronic patient record (EPR) is the digital patient file. It has existed since 2021. But almost nobody uses it: less than 1.5 percent of the population. It is considered a failure. A professor simply said: "The situation is desolate."

The DigiSanté program is supposed to build the foundations: uniform rules so that all computer systems understand the data the same way. (Experts call this interoperability.) DigiSanté costs around 625 million francs until 2034.

The mistake: Switzerland first built the file (EPR). The common rules (DigiSanté) come years later. That's the wrong order. A family doctor puts it this way: Everyone works on computers, but you can't exchange the data. You send PDF files by email. There are no common rules.

Who Is Allowed to Decide What?

The answer is sobering: Nobody is allowed to dictate to the cantons which software is secure enough.

• Clear rules apply to the federal administration. But they only apply to the federal government.
• Cantons and their hospitals decide for themselves.
• Private hospitals decide completely freely.

The data protection officers have also reacted: The association of Swiss data protection officers (called privatim) clarified a rule at the end of 2025. Authorities may not store particularly sensitive data unprotected with large foreign cloud companies. The reason: A foreign state could access it. Then you lose control.

Financial Control May Only Audit the Federal Government

The Swiss Federal Audit Office (SFAO) checks whether the federal government invests its money well. It has clearly identified the main problem: The federal government is supposed to achieve something but is not allowed to enforce it.

But the SFAO may only audit the federal government. It may not audit what the Canton of Bern does with Epic. But that's exactly where the most expensive decisions are made. This is a gap: The most important decisions lie outside of control.

What Could Be Done: Two Proposals

Proposal 1: The federal government builds its own, open platform. The dispute about which country a company comes from is pointless. International trade law prohibits simply excluding US companies. A different question is better: Does the software continue to run without the manufacturer? With open software (called Open Source) this is possible. The blueprint is open. Other experts can continue to operate it. This way control remains in Switzerland.

Proposal 2: Binding rules for hospitals – like in Scandinavia. Other countries show that it works. They also have multiple levels like Switzerland.

• Denmark: The data stays local. But there is a national body that makes fixed rules. Federal government, regions and municipalities support them together.
• Finland: There is a central national system. All hospitals must participate. Almost 100 percent of the data is in it.

Both countries have two things that Switzerland lacks: a national body with power to set rules, and an obligation to participate.

A simple lever for Switzerland: Whoever wants to bill with health insurance companies must meet fixed technical rules. This way the federal government could reach the hospitals – without first changing the constitution.

Conclusion

The question was: "Digitalization and federalism – is that even possible?" Denmark shows: Yes, it works. Even a country with many levels can succeed.

Switzerland's problem is not federalism. The problem is: Common rules are missing, and there's no body allowed to enforce them. As long as this remains the case, Switzerland's "digital sovereignty" is mainly a nice word – distributed across 26 cantons, a federal office and a federal chancellery, all saying: Actually, someone else is responsible.

The Most Important Points in Brief

• The federal government wants to keep foreign companies away from health data. The Canton of Bern buys exactly such a company (Epic) for 228 million francs.
• The digital patient record (EPR) has failed. Almost nobody uses it.
• The DigiSanté program is supposed to build the foundations – but too late and without power to enforce them.
• Financial control may only audit the federal government, not the cantons.
• Solution: an open federal platform and fixed rules for all hospitals, like in Denmark or Finland.

This is the simple language version. The detailed analysis with all sources can be found in the original version on clarus.news.

This text was created with the support of an AI model. Editorial responsibility: clarus.news | Fact-checking: 22.05.2026