TARMED / TARDOC revision

TARMED has been the national uniform pricing structure for outpatient medical services provided by doctors or in hospitals since 2004. TARMED has not undergone any fundamental changes in the past 15 years. As a result, it no longer properly reflects the current state of technical and medical progress. Doctors and hospitals bill services worth CHF 12 billion through TARMED each year. The tariff partners curafutura, FMH and MTK felt that the situation regarding TARMED, whose structure was outdated and no longer fit for purpose, was no longer tenable and have therefore spent the last few years working intently on the new TARDOC fee-for-service structure.

CSS considers the complete overhaul of TARMED, which is being conducted by the tariff partners, to be necessary. The existing TARMED tariff structure is outdated and leads to false incentives in the behaviour of service providers, which has negative consequences for both cost efficiency and the quality of service provision. Together with the accident insurers, the tariff partners curafutura and FMH have agreed on a fee-for-service tariff system that conforms with the law and is appropriately structured in accordance with business management criteria.

In July 2019, FMH and curafutura were finally ready to submit the pricing proposal they had developed jointly with the Medical Tariffs Commission (MTK), which is responsible for accident, disability and military insurance, for approval. The Federal Council's assessment showed that certain adjustments were still necessary. The tariff partners then resubmitted their proposal in June 2020 after making changes. With SWICA subsequently joining Tardoc and agreement being reached on a common concept of cost-neutrality, the Federal Council has been presented with a pricing proposal that is supported by the majority of health insurers and worthy of approval. The ball is now in the Federal Council's corner: it must approve Tardoc so that it can come into effect as of 1 January 2022.

The tariff structure must be continually monitored from the day it is introduced, and adjusted where necessary. Its weaknesses and inadequacies will not become apparent until it starts being used on a daily basis, and only then can they be remedied in a manner that is appropriate and fit for purpose. At the same time, the basis and conditions for the planned yearly revision and further development of the tariff structure can be established. To make the work still to be done by the tariff partners easier, CSS Insurance supports the creation of a national tariff agency (like SwissDRG) for the standardised outpatient service tariff. The existence of an agency of this kind could unblock the process and would most likely lead to a professionally drafted tariff structure that conforms with the law and is thus efficient.

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