Tardoc and first flat rates replace Tarmed medical tariff from 2026
Published: Wednesday, Jun 19th 2024, 15:40
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The outdated tariff structure for outpatient medical services called Tarmed will be replaced at the beginning of January 2026. On Wednesday, the Federal Council approved the new Tardoc single service tariff structure and the first outpatient flat rates. However, according to the national government, the two separately developed structures still need to be better coordinated.
The Tardoc single service tariff structure is based on so-called tax points, i.e. on the billable times and costs for a service. The tax point values are determined at cantonal level. Meanwhile, the flat-rate patient tariffs are based on fixed remuneration for all services throughout Switzerland.
Further coordination is "essential, as both structures affect the outpatient medical sector", said Health Minister Elisabeth Baume-Schneider to the media on Wednesday. According to the Federal Councillor, the approval of the two structures is therefore only partial.
This is primarily with reference to the concept of cost neutrality, according to which the transition from an old to a revised or new tariff structure must not lead to additional costs that are directly attributable to the change in structure. According to Baume-Schneider, this should make it possible to avoid unjustified cost increases. Risks in this regard should be minimized.
Adjustments would also have to be made to the flat rates: At present, their calculation is based exclusively on data from hospitals. Whether these are also suitable for doctors' practices needs to be examined in more detail. We need to understand where it will be more expensive and where not, Baume-Schneider continued. The state government is therefore demanding that the use of flat rates in doctors' surgeries be significantly reduced.
Reform of the tariff structure "essential"
In order to be able to introduce the two new structures at the same time, the tariff partners must therefore submit an implementation agreement to the Federal Council by November 1, 2024. This agreement will be drawn up under the leadership of the new Organization for Outpatient Medical Tariffs (OAAT AG).
If the tariff partners are unable to reach an agreement, the Federal Council will define the coordination rules so that the two structures can come into force, it was reported on Wednesday. This would also lead to pressure to reach a solution, said Pierre-Alain Schnegg, member of the cantonal government of Bern and President of OAAT AG.
Nevertheless, Federal Councillor Baume-Schneider described the introduction of the Tardoc single tariff structure and the first flat-rate patient tariffs on Wednesday as "essential for the healthcare system". The reform was "indisputable", especially "after years of deadlock between the tariff partners".
Associations welcome landmark decision
With the amendment to the Health Insurance Act (KVG) last year, Parliament made the rapid introduction of flat-rate tariffs possible, the Federal Councillor continued. OAAT AG also began its work in January 2024 and is now ensuring that coordination between the various tariff partners is guaranteed.
The Federal Council is convinced that this is the right time for the two tariff structures to come into force, continued the head of the Federal Department of Home Affairs (FDHA). According to Baume-Schneider, the task of OAAT AG is now the continuous further development of the tariffs.
The Conference of Cantonal Directors of Public Health (GDK) welcomed the Federal Council's decision on Wednesday to replace the Tarmed structure: it is urgent, as Tarmed no longer reflects the reality of service provision. A modern outpatient tariff structure is crucial.
Tariff partners, the hospital association H+ and the insurance association Santésuisse, also welcomed the Federal Council's decision in principle on Wednesday. At the same time, the two tariff partners regretted that only some of the flat rates submitted for approval will be implemented in the near future. The task now is to carefully prepare the introduction of the new medical tariff.
Long-standing dispute over tariffs
Tarmed, which has been in force since 2004, has never undergone a complete revision and has not been updated in recent years. The general opinion is that it is now outdated and needs to be replaced.
In compulsory health insurance (OKP), service providers - such as doctors and hospitals - prepare their invoices according to tariffs or prices that have been defined in tariff agreements between the tariff partners.
The tariff partners representing the service providers and their associations - such as the Swiss Medical Association FMH and the H+ hospital association - and the insurers and their associations, such as Curafutura and Santésuisse, have been working on the revision of Tarmed for years. In 2021 and 2022, the Federal Council was unable to approve the submitted versions of Tardoc as they did not meet the legal requirements.
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