TARDOC
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 The tariff partners curafutura, FMH and MTK felt that the situation regarding TARMED, whose structure was outdated and no longer fit for purpose, was no longer tenable and have therefore spent the last few years working intently on the new TARDOC fee-for-service structure.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 leads to false incentives in the behaviour of service providers, which has negative consequences for both cost efficiency and the quality of service provision.
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. curafutura and FMH jointly submitted documents supplementing their proposal (V.1.1) regarding the TARDOC tariff to the Federal Council in June 2020, having agreed on a joint concept for implementing its introduction in a cost-neutral way. In addition, by uniting CSS, Helsana, Sanitas, KPT and the recently joined SWICA, TARDOC brings together the majority of insured persons. curafutura and FMH jointly submitted version 1.2 to the Federal Council on 30 March 2021 and version 1.3 on 20 December 2021 in response to the FOPH report and the Federal Council's request for an adjusted version of TARDOC. Among other things, an extension of the cost-neutrality phase from one to three years, a project plan by the tariff office ats-tms AG for keeping TARDOC continuously updated, a tariff manual and expert opinions were submitted. Unfortunately, the two other tariff partners H+ and santésuisse could not be persuaded to take part and support TARDOC. In June 2022, the Federal Council again declined to approve TARDOC, but proposed doing so if specific demands regarding cost neutrality were met and a plan for remedying the further shortcomings identified in the FOPH report was presented. Furthermore, it believed that hospitals in particular should become involved in the new national tariff organisation. It found that TARDOC is based on a fee-for-service structure and can be approved as such. The Federal Council no longer expects TARDOC to be revised again before its approval. Work on this has now been completed, including limiting cost growth to 2% annually until supplementary flat-rate tariffs are introduced. All the tariff partners agree that TARDOC will be submitted jointly at the end of 2023 without further changes in content for entry into force on 1 January 2025.
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