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Market access for medical technologies in Switzerland

A brief overview of key market access pathways and challenges for medical devices, in-vitro diagnostic tests in the Netherlands

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Key topics

There are two key themes describing market access for medical technologies in Switzerland: 

  • Reimbursement: payment mechanism via DRG system, add-on reimbursement via ZE in hospital settings; payment via TARMED (soon to be replaced by TARDOC) catalog in out-patient settings
  • Funding: coverage decisions within the statutory health insurance by the Federal Office of Public Health

There is no health technology assessment challenge in Switzerland. HTA is integrated into funding decision-making.

Switzerland has one innovative payment scheme for medical technologies (Provisional reimbursement of medical procedures). 

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Reimbursement

Reimbursement for hospital procedures is made solely via the SwissDRG system. All cases of hospitalization with at least one overnight stay are reimbursed via DRG. Day cases and out-patient care are completely separate from hospital care provisions and are reimbursed via a fee-for-service model (TARMED catalog, soon to be replaced by TARDOC catalog, within the statutory health insurance).

The DRG system has the following components:

Diagnosis-related groups

  • DRGs are determined by the combination of a procedure code (CHOP) and a diagnosis code (ICD-10-GM). CHOP nomenclature is maintained by the Federal Statistics Office (BFS/UFS) and released annually
  • The base rate is determined nationally, and the Cantons have to approve and adopt it. In case they do not adopt it, the Cantons may set their own base rate (rarely the case) 

Add-on reimbursement (Zusatzentgelt, ZE)

  • Add-on reimbursement is provided for expensive devices, procedures, and drugs
    Tariff is typically determined on the national level by the administrator of the DRG system, SwissDRG

The SwissDRG system is approved annually.

Procedures performed in out-patient and day case settings are reimbursed via a fee-for-service mechanism via the TARMED (soon to be replaced by TARDOC) catalog.

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Funding

In the inpatient sector, medical devices/procedures are automatically reimbursed according to the so-called “principle of trust” unless they are questioned by a stakeholder of the system (typically insurance companies). In this case, the Federal Office for Public Health (FOPH) evaluates the questioned device/procedure and develops a coverage decision. 

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Specifics for IVD tests

In-vitro diagnostic tests are reimbursed using a fee-for-service mechanism via the List of Analyses (Annex 3 of the Healthcare Benefit Ordinance, KLV/OPre) in out-patient settings.

MTRC has experience with more than 145 projects in Switzerland

News and insights

30 Jan 2024

Approval of uniform financing of outpatient and inpatient care in Switzerland

In December 2023, the Swiss parliament adopted the uniform financing of outpatient and inpatient services (EFAS). Currently, inpatient benefits are financed jointly by health insurers and the cantons, whereas outpatient services are entirely funded by the insured. The EFAS will come into force in January 2028 and bring a uniform way of financing inpatient and outpatient services; the healthcare system is expected to be integrated into this system four years later.
22 Jan 2024

Timelines for 2024 applications for DRG changes in Switzerland announced

On January 3, 2024, the entity managing the DRG system in Switzerland, SwissDRG, announced that they will be accepting applications for changes in the DRG system from June 3, 2024, until July 15, 2024. The results of the DRG applications made in 2024 will be reflected in the 2026 version of SwissDRG.
10 Jan 2024

Overview of Swiss HTA program released by the Swiss Federal Office of Public Health

In mid-November, the Federal Office of Public Health released an overview of the Swiss HTA program in a presentation “Bridging the Gap: How to Align HTA and Health Care Decision Making in Switzerland”.

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