There are more in-patient surgical interventions performed in Switzerland compared with other European countries, even when an outpatient intervention would be appropriate from a medical point of view, in the interest of the patient and would require fewer resources.
The DFI decided that the six groups of interventions will be reimbursed only if performed in out-patient settings. The list has been drafted on October 4th, 2017, on the amendment of Annex 1 of the Insurance Benefits Ordinance. These are the groups of interventions (with CHOP 2017 codes):
- Unilateral interventions on varicose veins of the legs (Z38.5);
- Interventions on haemorrhoids (Z49.4);
- Unilateral interventions of an inguinal hernia (Z53);
- Explorations/surgeries on the cervix or uterus (Z67);
- Arthroscopy of the knee, including arthroscopic operations on the meniscus (Z80.26);
- Surgeries on tonsils and adenoids (Z28.2).
The Federal Office of Public Health (FOPH) has instructed the Swiss Health Observatory (OBSAN) to perform an analysis for selection of surgical procedures, and that is how the six groups of interventions have been chosen. The OBSAN has come up to a conclusion that the Cantons will save the most, more than 90 million CHF.
This change will come into force starting January 1st, 2019. The transition period will allow hospitals and insurers to adapt to the new organizational regulation. At the moment, derogatory criteria are also drawn upon the basis of which it will be possible to reimburse even the stationary treatments.
See the full report in Italian here (you can change to German or French in the top-right corner).
See the analysis by OBSAN in French (with German summary) here.
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