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CSS Insurance

TARMED 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 The existing TARMED tariff structure is outdated and leads to false incentives in the behaviour of service providers, which has negative consequences for both cost efficiency and the quality of service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. The foremost priority of any revision by the partners must be the appropriate restructuring of TARMED using evidence and data-based practices. This includes both making the necessary adjustments to the underlying cost models to bring them into line with current practice models, and modifying the intrinsic values, minute values and invoicing rules. CSS continues to support the professional tariff office ats-tms AG as a crucial factor in the complete overhaul and subsequent maintenance of the tariff structure, despite Hplus opting out at the end of 2018. CSS plays an active role in the necessary preparations through its involvement in curafutura. Thankfully, a joint nomenclature with tax points was adopted by the tariff partners in September 2018. ats-tms AG and the remaining partners – FMH, curafutura and MTK – intend to complete work on the tariff structure so that it can be submitted to the Federal Council for approval by mid-2019. The rules for applying the tariffs and for invoicing have still to be drafted and negotiated, along with the procedures for transcoding, cost estimation and standardisation. In accordance with the Federal Council’s revised stance on the issue, proposed tariffs are to be reviewed and set, as the case may be, by minority stakeholders. This sparks hope that a new tariff structure – and one that is fit for purpose – will ultimately be approved, even under these difficult circumstances.

The Federal Council ordered a second set of changes to be made to the tariff structure as of 1 January 2018. CSS welcomes this intervention, which should achieve cost savings of CHF 470 million. 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.

You can find further information on the topic of tariff partnership in our publication on health policies "im dialog" 2/2017 (in German).