Day surgery

On December 2, 2024, the Swiss Federal Office of Public Health published the changes that will occur to the Healthcare Benefit Ordinance (KLV/OPre), which determines coverage of medical services in Switzerland. The updates will enter into force on January 1, 2025, and they relate to the list of explicitly evaluated services (Annex 1 of KLV/OPre), outpatient-before-hospital services (Annex 1a), List of Tools and Equipment (Annex 2), and the List of Analyses (Annex 3).

On December 20, 2023, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) announced that from January 1, 2024, the catalog for ambulatory operations in hospitals (AOP catalog) will be significantly expanded – 171 interventional procedures will be included in the catalog.

The revised EBM (German Uniform Evaluation Standard) catalog came into force on January 1, 2023. The most significant changes concern introducing the EBM codes for several IVD tests and further promoting outpatient (day case) surgical services.

In late December 2022, the National Association of Statutory Health Insurance Physicians (KBV) published a detailed overview of the changes in the reimbursement of outpatient surgeries to be introduced in Germany in 2023, which are aimed at expanding the utilization of these procedures by physicians.

On September 14, 2022, the Evaluation Committee published a preliminary (so-called announcement) decision on the further development of the German Uniform Evaluation Standard (EBM) catalog, which regulates the reimbursement of services in the public outpatient sector in Germany and is updated once a quarter (four times a year).

On June 23, 2022, the National Association of Statutory Health Insurance Physicians (KBV) announced the first steps aimed to expand the utilization of surgical procedures within day case/outpatient settings (reimbursed via the German Uniform Evaluation Standard (EBM) catalog).

The French Ministry of Solidarity and Health constantly announces the new experiments initiated under Article 51 of the Social Security Financing Act. These experiments are focused on various topics concerning medical technologies and the organization of care. At the end of December 2021, new experiments were announced which relate to coordinated care of patients with long-term illnesses, telerehabilitation program for patients with COPD, care pathway for patients suffering from lymphedema, surgery for pterygium, and others.

Since 2018 the cost weight for a number of day surgery DRGs has become equal to the cost weight of the relevant hospital DRGs. In 2019 the number of DRGs has been extended, and in total 39 day surgery DRGs are included in the list in 2019.

Eleven new DRGs have been added in 2019, while three DRGs have been deleted. The significant changes have been made for disorders of the circulatory organs (MDC 5) and musculoskeletal, skeletal and connective tissue disorders associated with prosthetic surgery (MDC 8). They concern insertion of vagus stimulator, ablation of heart, percutaneous valve replacement, and others.

KCE issued a report, in which it reviewed provision of day surgery in Belgium, incentives for provision of day surgery in France and England and developed recommendations for incentive policy for day surgery in Belgium to policy-makers.