An overwhelming majority of Swiss voters have thrown out a proposal for a single health insurance company in their country.
The referendum was the latest in a series of attempts in the country to cut rising health insurance costs.
Under Swiss law, everyone must have a health insurance policy. There are 87 different companies to choose from, each offering a variety of policies. Health premiums have soared over the past decade.
The proposal for a single health insurance company and premiums based on income and wealth was launched by a family association in western Switzerland.
The proposal had the support of the political left, some trade unions and doctors' associations. But parties from the center-right, the right, the business community, government and parliament, as well as the health insurers, were against it.
Health insurance in Switzerland is compulsory. But the exact laws and insurers you can use depend on which canton you live in.
Expatriates seeking residence have to comply with the same rules as Swiss nationals, and residency depends on proving you have health insurance.
An unfortunate side effect of the failure to make the system the same across the country is that individual cantons can go their own way. Some happily accept evidence of international insurance as an exemption from the mandatory system. Others are more awkward, effectively forcing people to have both. There is no appeal; the canton is judge and jury.
In 2003 voters rejected a plan for health insurance to be funded by a rise in VAT with premiums set according to income and wealth. This would have replaced the current system of obligatory private health insurance as offered by 87 firms.
International health insurance: News update: April 2007