Switzerland

On June 19, 2023, the Swiss Federal Office of Public Health (FOPH) published the changes that will occur to the Healthcare Benefit Ordinance (KLV/OPre) and its Annexes, which determines coverage of medical services in Switzerland. Key changes relate to introduction of two codes for genetic tests, several extensions of Coverage with Evidence Development, and updates in reimbursement conditions for transcatheter aortic valve implantation. The changes entered into force on July 1, 2023.

On June 5, 2023, the application window for submitting applications for changes in the Swiss nomenclature of surgical procedures (CHOP), as well as for the SwissDRG system, was open. The deadline for submission of CHOP applications is September 17, while the deadline for SwissDRG submissions is July 17.

On March 22, 2022, the entity managing the DRG system in Switzerland, SwissDRG, announced that they will be accepting applications for changes in the DRG system from June 5, 2023, until July 17, 2023. The results of the DRG applications made in 2023 will be reflected in the 2025 version of SwissDRG.

On February 7, 2023, the entity working on the new out-patient flat-rates, Solutions Tarifaires Suisses AG, announced the beginning of the consultation process for the work on version 0.3 of the new out-patient flat-rate reimbursement system. The comments can only be submitted by the tariff partners that established this body (associations of health insurers curafutura and santésuisse, as well as the association of hospitals H+, an association of physicians FMH, and medical tariff commission MTK/CTM). The consultations can be submitted until March 31, 2023.

On January 27, 2023, the Swiss Federal Office for Public Health announced the update of Annex 3 of the Health Care Benefit Ordinance (KLV/OPre), which contains the list of reimbursed IVD tests (List of Analyses). Two new tests on Monkeypox virus check will be introduced in March 2023.

On November 30, 2022, the entity managing the DRG system in Switzerland, SwissDRG, has published the final version of the 2023 DRG system. In total, 21 new DRGs were introduced, and they concern cardiovascular, ENT, gastrointestinal, gynecology, neurovascular, pulmonary, and some other technology groups. Also, three new add-on reimbursement categories were introduced.

On December 1, 2022, 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 January 1, 2023, 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 Appliances(Annex 2), and List of Analyses (Annex 3).

On November 15, 2022, a new body called “Organization for Outpatient Physician Tariffs AG (OAAT)” was founded under the leadership of the Bernese government councillor. It involves all tariff partners (associations of health insurers curafutura and santésuisse, as well as the association of hospitals H+, the association of physicians FMH, and medical tariff commission MTK/CTM), who have joined forces in order to reach the goal of improving the outpatient reimbursement system.

On July 29, 2022, the Swiss Federal Statistics Office (UFS) published the 2023 version of the procedure code (CHOP) nomenclature in the German language. The newly introduced codes concern various technology groups, such as cardiovascular, gastrointestinal, in-vitro diagnostics, neurology and neurosurgery, interventional radiology, orthopedics, gynecology, and others.

In mid-June, the Swiss Federal Office for Public Health announced the update of the Annexes of the Services Ordinance (KLV/OPre). Annexes 1, 2, and 3 were updated. The updates related to the endocrine, IVD, and interventional radiology technology groups.

On June 3, 2022, the Swiss Federal Council rejected TARDOC outpatient tariff structure version 1.3, which was submitted in December 2021. According to the Federal Council, major progress has been made, but version 1.3 does still not meet the legal requirements, in particular cost neutrality.

In mid-May 2022, the Swiss Federal Office for Statistics announced that they will be accepting applications for changes in procedure code (CHOP) nomenclature from June 1, 2022, until September 18, 2022. The applications made in 2022 will be reflected in the 2024 version of the CHOP nomenclature.