Out-patient lump-sum payment packages suggested to the Swiss Federal Council

In June 2020, santésuisse (the leading organization of Swiss health insurers) and the Swiss Society of Surgeons (FCMH) have submitted a proposal to the Federal Council for the acceptance of 67 lump-sum payment packages for out-patient services. The lump-sum payment packages concern the following areas of care: hand surgery, radiology (MRI / CT), pediatric surgery, vascular medicine, eye surgery, and anesthesia.

The commonly acknowledged issue with the current reimbursement system is ineffective and unnecessary spending. Certain stakeholders of the out-patient reimbursement system proposed certain measures to increase the efficiency of spending. The following reasons set the basis for the rationale behind this action:

• The same treatment will always cost the same, based on the national tariff structure with a uniform cost model
• Eliminating the incentive of the care providers to bill unnecessary services (as TARMED / TARDOC are the fee-for-service catalogs)
• The set price is only paid if the corresponding quality standards are also met, as the care providers and hospitals who join (optional) the collective agreement for out-patient lump-sum payment packages must participate in a recognized quality program

In July 2020, eight more lump-sum payment packages were suggested to the Federal Council. More suggestions are expected in the near future.

However, according to the director of curafutura (another health insurers’ association), “these lump-sums will cover only less than 20% of out-patient services.  Furthermore, this framework is optional. The lump-sums are not opposed to TARDOC, but represent a complement, as the two systems can coexist. In many areas of out-patient care, the lump sum will hardly be a viable alternative. In many cases, billing for individual services (fee-for-service) is more appropriate; the lump-sums are not always a better way to contain health care costs.” (reference)

Read the original announcement in German (change to French or Italian in the top-right corner) here.

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