Voters in Switzerland have rejected plans for a single means-tested health insurance system, aimed at reducing the high cost of premiums.
Big pharmaceutical companies are important to the Swiss economy
Final results showed 71% of voters in Sunday's referendum opposed the reform.
Under Swiss law, everyone must have a health insurance policy, and there are 87 different companies to choose from, each offering a variety of policies.
Premiums, which take no account of an individual's income, have risen on average by 2.4% annually since 1990.
The elderly and the chronically ill have been hard hit by the increases.
But the Swiss government and centre-right parties opposed the reform plans, saying a single fund would be cumbersome and would not keep the cost of premiums down.
A recent OECD (Organisation for Economic Co-operation and Development) and World Health Organization report showed that the Swiss spend 11.5% of their gross domestic product on health, compared with an average 8.8% in other OECD countries.
The report advised an overhaul of Switzerland's health services, arguing that they should be run more efficiently, in order to ensure patients got value for money.
Many people find it difficult to get an insurance company to take them on at all, the BBC's Imogen Foulkes reports from Bern.
Others have their requests to adjust their policies rejected - for example upgrading to a single room during possible hospitals stays.
The proposal for a single health insurance scheme came originally from a family rights organisation, and had the backing of the centre-left Social Democrats, Swiss trades unions, and some doctors' associations.
It called for a merger of the existing 87 health insurance companies, and would replace their policies with one premium, calculated on a wealth and income basis.
The government said such a scheme would stifle competition.
The government has however offered Swiss cantons some funding to help reduce insurance premiums for people on low incomes.
A row over costs in the last few days before the vote caused confusion. Supporters of the plan claimed an average family of four would save about 300 Swiss francs ($250) a month under the new scheme.
Using the same figures, Switzerland's health insurers said the family would actually pay up to 200 francs ($150) more.
In recent years proposals to change the way hospitals are run and to promote more generic drugs have also failed.
One reason may be the power of the insurance sector, and of the big pharmaceutical companies in Switzerland - both are important to the Swiss economy and both have strong lobby groups, our correspondent reports.