The Swiss health system is highly complex, combining aspects of managed competition and “corporatism” (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. ( Bismarck Group of Health Systems ).
The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes.
The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good.
Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low- and middle-income households contribute a greater share of their income to the financing of the health system than higher-income households. Flawed financial incentives exist at different levels of the health system, potentially distorting the allocation of resources to different providers. Furthermore, the system remains highly fragmented as regards both organization and planning as well as health care provision. ( HSiT )
FROM TARMED TO TARDOC ( Tariff system for outpatient medical services )
TARDOC submitted to the Federal Council: after more than three and a half years of work, the new TARDOC tariff structure of the collective tariff organization ats-tms AG is ready. TARDOC replaces TARMED. The tariff partners FMH and curafutura submitted the TARDOC to the Federal Council for approval and entry into force on 1.1.2021.
The settlement of outpatient medical services has been carried out since 2004 with the so-called TARMED. In TARMED all outpatient medical services are shown. The TARMED is outdated and a revision was overdue.
What's new ?
Developing a new tariff structure which is acceptable to the collective health system partners and capable of consensus proved to be extremely demanding.
The cost models used are adapted to the current state of medicine, medical technology and today's personnel expenses. The treatment duration of the individual services has been updated. Thanks to medical and technical progress, many examinations today are less time-consuming and new services have been added. At the same time, the rapid professionalization of non-medical personnel in the last 20 years has led to new services not featured in today's TARMED. The tariff structure has been simplified. Thus, purely stationary services are eliminated and the Nomenclator from today’s 4600 positions reduced to around 2700 positions. The application and billing rules are redefined with the involvement of medical associations.
How does it continue?
FMH and curafutura have submitted the tariff structure TARDOC to the Federal Council. The MTK does not have to submit an application.
FMH and curafutura are committed to the principle of cost-neutrality according to Article 59c (1) (c) KVV. Service providers and insurers, however, have different views on how to handle the cost-neutral transfer from TARMED to TARDOC and therefore submit two variants of the tariff structure. The two versions differ only in the number of tax points.
The tariff structure TARDOC can be viewed at https://tardoc.ats-tms.ch.
About the ats-tms AG: In 2016, the ats-tms AG was founded with the aim of developing and continuously developing a revised tariff structure for outpatient medical services. The shareholders are the health insurance association curafutura, the medical association FMH and the medical tariff commission UVG (MTK)