The currently valid TARMED tariff structure in the outpatient medical sector will be replaced by the TARDOC single service tariff structure and the tariff structure for outpatient flat rates.
(red) The TARMED tariff structure, which is used to bill outpatient medical services, came into force in 2004. Since its introduction, it has never been revised in its entirety. The general opinion is that this tariff structure is now outdated and needs to be replaced. As the tariff partners were unable to agree on a revision of TARMED, the Federal Council had to intervene twice. It made use of its subsidiary powers in 2014 to adapt TARMED and in 2017 to adapt and define TARMED. For several years, the Federal Council has called on the tariff partners to jointly revise TARMED and submit a tariff solution that meets the legal requirements for approval.
TARDOC is the individual service tariff structure for outpatient medical services developed by the health insurance association curafutura and the Swiss Medical Association FMH. curafutura and the FMH submitted version 1.0 to the Federal Council for approval on July 12, 2019 (without having agreed on the amount of the tax points) and version 1.1 on June 25, 2020 (this time with agreement on the tax points). After reviewing TARDOC versions 1.0 and 1.1, the FOPH submitted a detailed review report to both parties. However, on June 30, 2021 and June 3, 2022, the Federal Council determined that the later versions (versions 1.2 and 1.3) could not be approved either because they did not meet the requirements for approval.
On December 1, 2023, curafutura and FMH submitted an application to the Federal Council for approval of version 1.3.2 of TARDOC, while santésuisse and H+ submitted an application to the Federal Council for approval of version 1.0 of the flat-rate patient tariff structure.
Similar to TARMED, TARDOC is an outpatient single service tariff that allocates tax points to medical services. The product of the standardized nationwide tax points and the cantonally or regionally agreed tax point value forms the price of the service. The price of the service is the product of the standardized nationwide tax points and the tax point value agreed at cantonal or regional level.
The patient flat rate structure comprises a number of case groups that are assessed in relation to each other. The amount of the valuation is expressed in relative weights (cost-weights). For invoicing purposes, the cost-weights from the tariff structure are multiplied by a Swiss franc value to form the price of the service. This franc value is agreed on a cantonal or regional basis.
On June 19, 2024, the Federal Council simultaneously approved TARDOC and the outpatient flat rates so that they can be introduced on January 1, 2026. However, this is a partial approval and adjustments are still required before introduction.
Source: www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Aerztliche-Leistungen-in-der-Krankenversicherung/revision-tarif-ambulante-aerztliche-leistungen.html (last accessed on 19.08.2024).
InFo ONKOLOGIE & HÄMATOLOGIE 2024; 12(4): 36
