The aim of this research is to explain long-term care policy change at the Swiss federal level. We focus on the inclusion of long-term care (LTC) in the new Health insurance law (LAMal) adopted on 1994. Until the middle of the 1990s, the Swiss health-care policy was largely characterized by “the minimal form of government intervention”. With concerns to LTC, this was particularly true: issues related to the care of the older people were decided at regional and local levels by administrators. The LAMal, which is currently the cornerstone of the Swiss health-care system, introduced a major change in the field of LTC. For the first time, LTC was included into the mandatory health-care benefits package. First of all, the compulsory health insurance started to covert both, institutional LTC (services supplied in stationary structures, semi-stationary structures, and in residential care homes), as well as home-based care. Second, residential care homes and home-care organizations were recognized as providers. Independently of the level of generosity of this reform, the inclusion of LTC on the LAMal represents a major shift: a movement towards the centralization of long-term care competences. With the introduction of the 1994’s law, the 26 LTC cantonal legislations became regulated at the federal level. Assuming that federalism shapes the capacity of states government to undertake reforms (Campbell 2003), we argue that the study of the complex field of LTC policy may show us some evidences about (social) policy change in federal states. By analyzing the process of the LTC reform, we achieve two goals: First, we may explain how LTC became a national issue. And second, by focusing on the bargain between policy-makers actors taking place in the (three) different but interconnected arenas, we may show in which extend the federal structure has shaped the dynamics of the Swiss LTC policy. Theoretically, this research will mobilize an actor centred approach. It integrates, on one hand, analyses of policy documents (reform projects, commission reports, position papers, parliamentary debates), and on the other hand, in-depth interviews with experts and officials in the level of policy formulation and decision making.
