Specialist doctors warn that many procedures may soon no longer be financially viable
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Saving in the healthcare system
Flat rates for outpatient procedures are intended to curb the rise in premiums. 
Doctors and the pharmaceutical industry warn of a decline in quality and are calling for the new tariff to be postponed.
Also read the NZZ article of 29 April 2025 by Markus Brotschi
Red text and drawing = our comments
Politics & Business – Tuesday, 29 April 2025 – Markus Brotschi
Around 15 billion francs – more than one third (up to the end of 2025) of health-insurance premiums – are spent every year on outpatient treatments in practices and hospitals. For these outpatient services, the Federal Council will introduce a new tariff system in 2026. The final decision will be taken by the Federal Council soon.
All the trickery with the incredible, sometimes inhumane tariff items (red arrows) and the many secret contracts would be unnecessary if the money-hungry managements simply and honestly – like any normal company – billed the time actually spent by everyone involved in providing a service. But of course, that would bring in far less money!
This officially ends a major dispute between the associations of health insurers, hospitals and the medical profession. But behind the scenes, things are still simmering among doctors. Although the delegates’ assembly of the Swiss Medical Association FMH approved the new tariff by more than 80 percent.
However, specialist medical organisations are warning about the new flat-rate tariffs, which provide a fixed price for certain procedures.
Until now, outpatient treatments were billed using individual items, meaning the price varied depending on the effort involved.
That’s simply how it is: similar operations, etc., can take more or less time – nobody should have to rush because of the payment.
Warning of two-tier medicine
The flat rates have serious shortcomings that would jeopardise the quality of outpatient care in Switzerland warn 29 medical specialist societies in an open letter. Two-tier medicine and a loss of quality are looming. Some flat rates were allegedly calculated incorrectly.
Complex treatments would become unprofitable because the flat rates do not cover costs. An alliance of specialist societies, the pharmaceutical association Interpharma and the association representing private hospitals (Ospita) is calling on Health Minister Elisabeth Baume-Schneider to postpone the introduction of the new tariffs to 2027 according to the NZZ.
In medical circles, there are even occasional threats that patients would be shifted to hospitals for procedures that are not cost-covering. Or that more complex treatments would be split across several consultations so that a separate flat rate could be billed for each step instead of just one for the entire treatment.
Sad, sad!
One example of such warnings is a statement by Retina Suisse, the association for people with eye diseases. The six-page warning paper was coordinated with the Swiss Ophthalmological Society the association of ophthalmologists.
As an example, the treatment of age-related macular degeneration (AMD) is cited, which many older people suffer from and which leads to a loss of visual acuity. The condition is treated with injections into the eye administered at intervals of a few months in outpatient practice.
Until now, the treatment was billed using several tariff items for the individual steps of the procedure. In particular, ophthalmologists were able to bill the administered medication separately. Now the treatment is remunerated with a flat rate of around 1,300 francs.
It does not matter which drug is injected even though its price varies between 678 and 545 francs depending on the product.
This is where the criticism begins. Doctors would be pushed by the fixed price to use the cheapest drug. In the case of AMD, this would be a so-called biosimilar a copycat product of the original biotechnologically manufactured medicine says Stephan Hüsler, Managing Director of Retina Suisse.
However, the more often the cheaper product is prescribed the lower the flat rate becomes. Because the flat rates were designed as a “learning system”.
The organisation Ambulant Medical Tariffs (OAAT), founded for the new tariff system, regularly reviews the costs of a treatment and adjusts the price. If, in AMD treatment, the cheapest drug is injected frequently the flat rate falls.
The resulting price pressure would make it impossible in the future for patients to benefit from new, more effective but more expensive drugs Hüsler warns. In addition, prescribing the cheaper biosimilar would have a paradoxical cost effect. Because the copycat product would need to be injected more often than the original more consultations per year would be necessary and the flat rate would be billed more frequently.
Family doctors and paediatricians need a new tariff
The Federal Office of Public Health (FOPH) points out that the flat rates correspond to an average value of the recorded cases. It is therefore in the nature of things that some cases are more expensive and others cheaper than the flat rate defined for the treatment. Despite the criticism, the Federal Council is likely to stick to introducing the new outpatient tariff system in 2026. Both the FOPH and the FMH point out that any deficiencies in the flat rates can still be corrected by the tariff commission before their introduction.
Even in the year after introduction, the tariffs will be continuously updated and adjusted if necessary the FOPH states. Whether it will succeed in correcting all the criticised shortcomings before the introduction of the new, complex tariff system remains open. What matters, however is that the completely outdated Tarmed is replaced. In particular, paediatricians and family doctors as well as psychiatrists urgently depend on the planned improvements in the new set of rules called Tardoc.
That flat rates are being introduced alongside the new itemised tariff Tardoc which replaces the more than 20-year-old Tarmed is largely due to the health-insurer association Santésuisse. This association opposed Tardoc for a long time which was negotiated by the now dissolved rival association Curafutura and the FMH. The flat rates are intended to create pressure to provide medical services at lower cost.
Flat rates exist for around 120 common procedures such as inserting a pacemaker cataract surgery or removing tonsils. A large proportion of treatments will, however, continue to be billed with individual items especially family doctor services.
Outdated tariff encourages a high density of scanners
That the still valid Tarmed must be replaced is shown by the audit of the Swiss Federal Audit Office (SFAO) on the use of computed tomography (CT) and magnetic resonance imaging (MRI) scanners.
Imaging examinations cause annual costs of 2.1 billion francs which corresponds to one sixth of outpatient treatment costs. Of this, 600 million are attributable to ultrasound – and 850 million to CT and MRI examinations.
The Audit Office sees Tarmed as one reason for the large number of scanners. “The favourable tariff climate has led to the development of an extensive and convenient service offering” the report states. The new outpatient tariff Tardoc will lead to lower contributions to the infrastructure of radiology institutes. The FOPH must, however, closely monitor whether this is compensated for by a higher number of examinations.
Front page
Specialist doctors warn that many procedures may soon no longer be financially viable
Saving in the healthcare system:
Flat rates for outpatient procedures are intended to curb the rise in premiums.
Doctors and the pharmaceutical industry warn of a decline in quality and are calling for the new tariff to be postponed.
Some outpatient operations will in future be billed at a fixed price.
Photo: Christian Jaeggi
In 2023, Switzerland’s healthcare system cost 94 billion francs 2.4 percent more than in the previous year. The Federal Statistical Office (FSO) announced this yesterday in a media release. The healthcare system was financed by households to more than 60 percent either directly or via health-insurance premiums.
According to FSO estimates, costs are expected to rise by more than 3 percent in 2024.
The costs for care services which are provided among other places in hospitals, medical practices and socio-medical institutions increased by 6 percent between 2022 and 2023. The increase in the costs of health goods such as medicines or therapeutic devices was somewhat more moderate at +3.4 percent. In 2023, care services and health goods together accounted for more than three quarters of the costs of health services.
Less for prevention
In 2023, total spending on prevention was 53.5 percent lower than in the previous year which had still been shaped by the Covid-19 pandemic. Less than 2 percent of total healthcare costs in 2023 were spent on it. The costs for laboratory analyses also declined (-8.9 percent). In contrast, radiology costs continued to rise (+7.0 percent). The increase in administrative costs which primarily cover the administrative workload of health insurers was particularly striking in 2023 at 9.6 percent.
Hospitals, at 36.3 percent of total costs, were the most important service providers. Hospital costs increased by 4.5 percent between 2022 and 2023. For doctors’ practices of all specialities, cost growth was 7.1 percent and 4.6 percent for socio-medical institutions. The increase was particularly strong for Spitex services (+7.9 percent) although these costs accounted for less than 4 percent of total healthcare costs.
Cantonal differences
In 2023, the highest healthcare costs were recorded in the canton of Basel-Stadt (13,600 francs per capita). At the other end of the ranking, costs in the canton of Zug were almost 40 percent lower (8,600 francs per capita). The share of costs for outpatient services ranged from 53.4 percent in the canton of Geneva to only 34.8 percent in the canton of Uri.
Private households are the most important financing pillar of the healthcare system. They paid 21.8 percent of healthcare costs out of pocket and 39.5 percent in the form of indirect contributions mainly via health-insurance premiums. The remaining amount was largely covered by the cantons. Household healthcare expenditure rose by 4.7 percent between 2022 and 2023 while that of the cantons rose by 1.9 percent.
Nicoletta Gueorguiev
1016x
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