Switzerland

In March 2025, the entity managing the DRG system in Switzerland, SwissDRG, announced that they would be accepting applications for changes in the DRG system from June 2, 2025, until July 14, 2025. The results of the DRG applications made in 2025 will be reflected in the 2027 version of the SwissDRG.

On February 18, 2025, the Swiss Health Observatory (Obsan) published its 2023 report confirming the ongoing shift from inpatient to outpatient care in Switzerland. The number of procedures required to be performed in outpatient settings to be reimbursed expanded from six in 2019 to 18 in 2023, with outpatient costs two to eight times lower. Despite the shift, overall healthcare costs have risen due to an increase in treatment volumes.

On January 6, 2025, a new association in the Swiss health insurance industry, prio.swiss, began operations. It consolidates the efforts of two former associations, curafutura and santésuisse, and takes over their activities to represent the political and economic interests of the insured. The prio.swiss represents approximately 90% of individuals insured under Swiss mandatory health insurance system (OKP).

On December 12, 2024, the entity managing the DRG system in Switzerland, SwissDRG, published the final (billing) version of the 2025 DRG system. In total, 23 new DRGs related to cardiovascular, gastrointestinal, nephrology and urology, neurology and neurosurgery, obstetrics and gynecology, orthopedics, pulmonary and airways, and some other areas were introduced. Also, 17 new add-on reimbursement categories were implemented.

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 October 31, 2024, the Swiss Federal Statistics Office (UFS) released the systematic version of the procedure code (CHOP) nomenclature for 2025. The nomenclature is now available in German, Italian, and French languages and will come into force on January 1, 2025. Multiple new procedure codes were introduced in various fields, including endoscopy, extracorporeal treatments, in-vitro diagnostics, interventional radiology, obstetrics and gynecology, orthopedics, and radiotherapy.

On September 18, 2024, the Organization for Outpatient Physician Tariffs (OAAT) AG announced that the comprehensive tariff system, including the TARDOC catalog of individual service tariffs and outpatient flat rates, is now available for review by interested parties. As emphasized by the OAAT AG, the new system has not been approved yet. After the partial approval by the Swiss Federal Council in June 2024, the implementation of the new system was postponed until January 2026.

On June 19, 2024, the Swiss Federal Council granted partial approval to the new outpatient reimbursement system, consisting of the TARDOC catalog of individual service tariffs and the flat-rate system, which were developed independently. Adjustments were requested to ensure better coordination and adherence to cost neutrality. The full implementation of the new system is now postponed until 2026.

On June 18, 2024, the Swiss Federal Office of Public Health published the changes that will occur to the Services Ordinance (KLV/OPre), which determines coverage of medical services in Switzerland. The updates will enter into force on July 1, 2024, 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 List of Analyses (Annex 3).

The application window for changes in the Swiss classification of surgical procedures (CHOP) will open on June 3, 2024. The eligible applicants can submit applications until September 15, 2024.

On May 1, 2024, the Swiss Federal Council adopted a message to amend the Federal Health Insurance Act (KVG) following a parliamentary mandate, which requires a change in how tariffs for laboratory analyses are determined. Instead of being set by the Federal Department of Home Affairs (FDHA), the tariffs of tests in the List of Analyses will be determined through negotiations between collective bargaining partners, streamlining the inclusion of innovative analyses and slowing down the increase in healthcare costs.

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.