SWITZERLAND: An Introduction to Healthcare
The Swiss healthcare sector is currently undergoing major changes. The most noteworthy ones are discussed below.
Introduction of a New Outpatient Physician’s Tariff
At present, doctors working on an outpatient basis are reimbursed by the health insurance companies via the Tarmed tariff. However, Tarmed is outdated. It will be replaced by the new TARDOC single service tariff structure and a tariff structure for flat rates from 2026. The Federal Council partially approved both tariff structures and defined requirements for the introduction of the two tariffs.
Laboratory Tariffs
In future, the tariffs for laboratory analyses will no longer be set by the authorities but will be negotiated between the tariff partners (laboratories/health insurance companies). The Federal Council’s dispatch was adopted in spring 2024. The matter is currently being discussed in Parliament.
Underfunding of Hospitals
Hospitals in Switzerland are reimbursed by the health insurance companies via flat rates per case (SwissDRG). For some years now, these flat rates per case have no longer been sufficient, partly because inflation has not yet been factored in. Paediatric medicine, which is chronically underfunded, is particularly affected. Many hospitals are in financial difficulties, some are receiving state aid and rescue packages, while others have already had to close.
Distribution Battle for Highly Specialised Medicine
In the area of highly specialised medicine (eg, severe burns, organ transplants), service contracts are awarded to hospitals throughout Switzerland. A distribution battle has broken out over these service contracts. In the opinion of various hospitals, areas are being designated and allocated as highly specialised medicine which have long constituted standard treatments. Also, hospitals that are highly uneconomical and supported by state aid are also being entrusted with service contracts despite the paramount requirement of economic efficiency.
Controversial Cantonal Hospital Lists
The awarding of service contracts in normal, non-specialised medicine is also controversial. A number of appeals by hospitals from various cantons are currently pending before the Federal Administrative Court. Planning for a cantonal hospital is a challenging task, which the cantons sometimes fail to perform adequately.
Uniform Financing of Inpatient and Outpatient Services
A major legislative project recently came to a positive conclusion. Outpatient and inpatient acute services are to be financed uniformly from 2028; care services will follow four years later. Until now, 55% of inpatient costs have been borne (jointly) by the cantons (taxpayers) and 45% by the health insurance funds (premium payers); outpatient costs, on the other hand, were covered in full (100%) by the health insurance funds. Both areas are now to be borne equally by the health insurance funds and the cantons.
Shift from Inpatient to Outpatient Procedures
Since 2023, a nationwide “outpatient before inpatient” regulation has been in force. This regulation applies to selected groups of elective – ie, non-urgent, procedures on patients who are generally in good health. Only if these procedures are performed on an outpatient basis will they be reimbursed by the health insurance company. The aim is to promote appropriate outpatient service provision where it is medically appropriate, patient-oriented and saves resources. The list of procedures that should be performed on an outpatient basis wherever possible is revised annually and adapted in line with new findings and medical progress.
Restriction on Doctors (“Doctor Freeze”)
In 2023, caps have been introduced in many cantons to limit the number of doctors who may work at the expense of the health insurance fund. Following a ruling from the canton of Basel-Landschaft, which demanded a legal basis for the caps at cantonal level, many cantons have suspended the proposed introduction of caps. There are currently different regulations of caps in place in the various cantons.
Digitalisation
Switzerland has one of the highest-quality healthcare systems in the world. In contrast to other areas of life, however, digitalisation in the healthcare sector is much less advanced. The DigiSanté programme aims to reduce Switzerland’s backlog in the digitalisation of the healthcare system and catch up with the frontrunners by 2034. The DigiSanté programme comprises numerous projects and will be implemented in several phases. The first step involves the creation of a clear legal and organisational framework as well as the technical requirements to enable information to be exchanged seamlessly. The second step involves the creation of a national infrastructure to enable the rapid implementation of new, digital healthcare services.
Electronic Patient Record (EPR)
The Federal Act on the Electronic Patient Record sets out the framework conditions for the introduction and dissemination of the electronic patient record. The Act will undergo comprehensive revision over the next few years. The draft bill comprises the following basic parameters:
- Tasks and competencies will be divided between the Confederation and the cantons to ensure the long-term financing of EPRs.
- To promote the use of EPRs, an EPR will be opened automatically and free of charge for every person resident in Switzerland with mandatory health insurance or military insurance.
- All healthcare professionals working in an outpatient setting will be required to maintain EPRs and record treatment-relevant data on patients in EPRs.
- Patients will be able to give express consent to making non-anonymised medical data in their EPR available for research purposes.
- The use of a future national e-ID (electronic identification) to access the EPR is also envisaged.
The developments outlined above have a considerable impact on market participants in the healthcare sector. The effects are not only economic (cost pressure), but also legal (need for adaptation, legal uncertainties, etc) and it remains to be seen how these challenges will be addressed at both cantonal and federal levels.