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Long COVID and ME/CFS in Switzerland: From pandemic aftermath to a strategic test for health insurers
Long COVID is becoming a structural challenge for chronic care, work ability and coordination across the health and social insurance system. For Swiss health insurers, the primary task is not to create another stand-alone product. It is to build better data, clearer care pathways and stronger reintegration across institutional boundaries.
Long COVID is no longer just a story from the pandemic. It is increasingly a test of how well Switzerland manages complex chronic conditions that cross medical, insurance and workplace boundaries. Symptoms can include fatigue, cognitive difficulties and respiratory problems; but for people with severe or persistent illness, the defining issue is often not one symptom in isolation. It is reduced functional capacity - the ability to manage everyday life, participate in society and remain in work.1
Switzerland has already responded. Primary care providers, specialist consultations and rehabilitation services are available. In June 2026, the Federal Office of Public Health held the launch event for a national strategy on ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and post-COVID-19 condition, bringing together more than 50 experts from patient organisations, healthcare providers, health insurers, disability insurance, cantons and other institutions. However, the system is still developing: data remains fragmented, standards are evolving and coordination is not consistently effective.2
For boards and executive teams of insurers, this creates an important but manageable agenda. Long COVID is more likely to appear as a persistent portfolio of heterogeneous, longer-term and coordination-intensive cases, rather than as a sudden clearly defined cost shock.
Three messages stand out:
- Functional capacity matters more than any single symptom.
- Switzerland has a care infrastructure, but data, standards and coordination need further improvement.
- The main insurance lever lies in mandatory health insurance, and at the interfaces between daily sickness benefits, disability insurance and employers.
The strategic issue is function, not fatigue
Long COVID is an umbrella term for persistent symptoms following a SARS-CoV-2 infection. ME/CFS is a more specific, chronic multi-system condition. The two terms are not interchangeable: not every person with Long COVID has ME/CFS. However, some people with Long COVID develop ME/CFS symptons.
One particularly important feature of ME/CFS is post-exertional malaise: a worsening of symptoms following physical, cognitive or emotional effort that would previously have been manageable. ME/CFS goes far beyond general tiredness and can substantially restrict physical and mental functioning. 3, 4
For insurers, this distinction is more than medical terminology. Claims processes naturally follow diagnoses, treatments and service categories. The human and economic impact, however, follows functional capacity: Can a person manage daily activities? Can they work reliably? Does their condition stabilise, improve or fluctuate?
This is why cost of treatment alone is an incomplete measure. Case management and outcome measurement should also consider function, work ability and stability over time.
Switzerland has responded, but the system is still taking shape
The available evidence points to a relevant but difficult-to-measure population. A mathematical model published in 2025 concluded that in 2023, at least 1% of the Swiss population was affected by the longer-term consequences of COVID-19. However, the researchers reported a very wide range across the different modelling scenarios - this estimate should be understood as a planning reference rather than a precise registry count.5
Data from the Federal Social Insurance Office provides a different perspective. By the end of 2023, an estimated 2,900 people with Long COVID had registered with Swiss disability insurance, representing 1.8% of all new registrations. In nine out of ten cases, the individuals were certified as 100% unable to work at the time of registration. 6
These figures do not suggest that Long COVID is driving a system-wide volume shock in disability insurance. Rather, they show that Switzerland faces a persistent population of affected people and a smaller group of severe, long-running cases with substantial consequences for work ability.
The challenge is compounded by the absence of a compulsory Long COVID register. The Federal Office of Public Health has concluded that such a register is not feasible under current conditions, owing to the heterogeneity and fluctuation of symptoms and the lack of a legal basis. Instead of waiting for one definitive dataset, insurers will therefore need to develop their own evidence base carefully - while remaining transparent about its limitations.2
For insurers, this is primarily a steering challenge - not a new product category
The insurance logic is relatively clear. Medically necessary assessment and treatment sit primarily within mandatory health insurance. Supplementary insurance can add value selectively through navigation, access, second opinions and complementary support services. However, these services should address a demonstrable need and avoid adding complexity or creating expectations that the available evidence cannot support.
The greatest economic and societal leverage often lies at the interfaces: between medical care and daily sickness benefit insurance, between treatment and disability insurance, and between recovery and the workplace. Long COVID frequently materialises not within one insurance product, but at the transition points between healthcare, income protection, reintegration and employment.
Delayed handovers, unclear responsibilities and fragmented communication can prolong the uncertainty for everyone involved. Long COVID therefore does not fit neatly into a product silo. It is a test of whether insurers can connect medical steering, service quality, work reintegration and outcome measurement.
Five priorities for boards and executive teams
Leadership questions to take into the boardroom
- Can we identify Long COVID and ME/CFS-related cases reliably in our portfolio today?
- Which providers and rehabilitation partners should form a quality-assured pathway?
- How do we connect mandatory health insurance, daily sickness benefits, disability insurance and employers early enough?
- Which outcomes do we measure beyond cost - especially function, work ability and stabilisation?
- What role do we want to play in the national strategy and in future data partnerships?
From pandemic legacy to future capability
The most likely development is not an abrupt market disruption. It is a gradual but sustained increase in strategic relevance. Long COVID will continue to test the ability of the Swiss healthcare system to manage conditions that are chronic, fluctuating, difficult to standardise and closely linked to social and economic participation.
Insurers that build capabilities now will be better prepared not only for Long COVID, but also for ME/CFS and a wider group of post-viral syndromes. These capabilities are transferable: better case identification, trusted provider networks, coordinated reintegration and outcome-based steering.
Long COVID is therefore more than a residual issue from the pandemic. It is a test of future readiness. The question is not simply whether insurers can finance care. It is whether they can help the system recognise complexity earlier, coordinate support more effectively and enable people to regain stable function.
That is where responsible insurance leadership can make a meaningful difference.
Authors
- Dr. Marcel Thom, Partner, Insurance Lead, Switzerland
- Nicolas Himmelspach, Senior Manager, Insurance
- Nadia Stucki, Manager, Insurance
- Stephanie Gross, Senior Consultant, Insurance
- Finn Wagner, Senior Consultant, Insurance
