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 The tariff partners curafutura, FMH and MTK felt that the situation regarding TARMED, whose structure was outdated and no longer fit for purpose, was no longer tenable and have therefore spent the last few years working intently on the new TARDOC fee-for-service structure.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. In March 2021, Curafutura and FMH then jointly submitted a revised version of TARDOC (V.1.2) to the FOPH in response to the latter's observations in the evaluation report. Changes and additions included extending the cost-neutrality phase from one to two years, a project plan by the tariff office ats-tms for keeping TARDOC continuously updated, a tariff manual and expert opinions. Unfortunately, the Federal Council failed to approve the TARDOC proposal at the end of June 2021, stating that it expected TARDOC to be revised jointly by all the tariff partners and resubmitted by the end of 2021.The tariff partners jointly defined the priority points for revision, on the basis of the FOPH's evaluation report: simplifying tariffs, creating transparency, ensuring cost neutrality. This work was completed, and a revised tariff proposal TARDOC version 1.3 was submitted to the Federal Council by curafutura and FMH in December 2021. Unfortunately, the two other tariff partners H+ and santésuisse could not be persuaded to take part and support TARDOC. The ball is now back in the Federal Council's court, and probably for the last time: it must approve TARDOC to enable it to come into effect as of 1 January 2023.
Outpatient tariff organisation
In the summer of 2021, as part of the 1a package of measures to contain costs, the Swiss Parliament decided to make the establishment of a tariff organisation for outpatient medical services compulsory. Project work on setting up this organisation is ongoing. This tariff organisation will have an important role in ensuring that outpatient tariff structures are regularly updated and adapted as necessary in the future.