TARMED / TARDOC revision

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 The existing TARMED tariff structure is outdated and leads to false incentives in the behaviour of service providers, which has negative consequences for both cost efficiency and the quality of service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. On 9 July 2019, the board of curafutura unanimously decided to approve the new TARDOC outpatient tariff structure. In doing so, it agreed to the submission of the Tardoc package, including the demand that the introduction of Tardoc be cost neutral (Art. 59c, para. 1 let. c KVV) in comparison with the existing procedure of ex ante approval and ex post correction of tariffs. The tariff partners curafutura and FMH were thus able to hand over the revised TARDOC tariff structure to the Federal Chancellery on 12 July 2019, after more than three years of work. A new milestone on the road to the new fee-for-service tariff system has thus been reached. 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. The two partners have also joined forces to advocate for a cost-neutral transition from TARMED to TARDOC, although there are different views on this can be achieved. It is now up to the FOPH to define ‘cost-neutrality’ in law. Not all of the tariff partners took part in the submission of the tariff structure, with both H+ and santesuisse missing. However, the Federal Council can only approve a tariff structure and bring it into force if it is submitted by a majority of the tariff partners. The FOPH is now called upon to review this tariff structure and send it out for consultation. The FOPH and Federal Council can then make adjustments to the proposed tariff structure and bring a revised version into force that is binding on all the tariff partners. The new structure would apply from 1 January 2021 at the earliest. 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.