Switzerland

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.

On April 1, 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 6, 2022, until July 17, 2022. The results of the DRG applications made in 2022 will be reflected in the 2024 version of SwissDRG.

On March 10, 2022, santésuisse announced that the Swiss Federal Department of Home Affairs (FDHA) had decided to reduce the tariffs for laboratory tests, which is a consequence of santésuisse's repeated call for price reductions in the previous years. Santésuisse expects the price reduction to be substantial and to enter into force soon.

On March 24, 2022, the entity developing the new outpatient lump-sum reimbursement system (Solutions Tarifaires Suisses AG, STS) announced that they are currently working on updating the system, which will be open for consultation again at the end of 2022 and then submitted to the Federal Council for final approval. The introduction of the new reimbursement system is expected in 2024.

On December 20, 2021, the tariff partners of the novel TARDOC reimbursement system for outpatient care (association of health insurers curafutura and association of physicians, FMH) re-submitted the substantially revised version 1.3 of TARDOC to the Federal Council. The tariff partners hope that the Federal Council will assess the new reimbursement system in the first quarter of 2022 and that it could be implemented from January 2023.

In 2015, the Federal Office for Public Health launched an HTA program intending to reassess the benefits already reimbursed by compulsory health insurance. The following ongoing re-evaluations are in progress: multigene expression tests in breast cancer, cardiac catheterization for coronary artery disease, invasive procedures for coronary artery disease, removal of osteosynthesis materials, etc.

On July 30, 2021, the Swiss Federal Statistics Office (UFS) published the 2022 version of the procedure code (CHOP) nomenclature in the German language. The newly introduced codes concern various technology groups, such as cardiovascular, gastrointestinal, neurology, interventional radiology, orthopedics, gynecology, and others.