Thursday , October 21 2021

Medical fee agreement – Switzerland: standard


Year after year, doctors and hospitals charge hospitalization services worth around 11 billion Swiss francs over that outdated tariff. The result is incentives for unnecessary benefits and improper distribution of premium funds – some of them getting too much, others too small. All this is indisputable. However, all attempts failed to change the tariff (marked).

Now there are signs of improvement: On Tuesday, the FMH Medical Association, the Curafutura Health Insurance Association and accident insurers announced that they had agreed on a so-called performance structure, which is the basis for a new tariff. Instead of today more than 4500 items for personal services, there is only "2800" in the new structure. Each service, it is set how many taxis points the doctor can charge. The price it receives, however, ultimately depends on how high the tax point is. These – defined in Swiss francs and currencies – are treated separately by doctors and health insurance in every canton.

The price problem remains open

The participants did not hide in the media that there is a need for serious discussions in order to agree on this structure. Others will move, because the project is not its destination. The partners still need to negotiate rules for proper implementation and billing. Particularly controversial are the limitations that determine how long, for example, the consultation may take or how many appointments a psychiatrist can charge per month.

Even more difficult is the cost issue. According to the law, the introduction of the tariff does not have to cause a jump in cost. Say: Should GP get more, other doctors will get less. How to solve this problem, left the partners yesterday open meaning. The goal is to submit the new tariff to the federal government in mid-2019.

I hope it is true that participants can clarify a particularly difficult point: they agreed at the level of so-called medical reference income. The benefits of doctors not only give a lot of political talk, since the federal government has recently published a controversial study on it, but they have also done in preparing the new tariff for Red heads. How do you determine how high a "normal" income of an independent full time employee should be? They have obtained expert reports comparing doctors with other freelancers such as dentists, architects and lawyers. Finally, the comparison with hired medical staff at the hospitals proved self-evident, explains Christoph Haudschild, CEO of ats-tms AG, who founded the partners to prepare the tariff, and agreed to use the average gross salary of the medical staff at 196,000 francs As well as national insurance contributions, which the self-employed pay themselves completely, resulting in an income of 229,000 francs, which apparently includes a relatively generous contribution to the second page.

Missing important players

Heidenshild stresses, however, that no false conclusions should be drawn from this number. It is the size of the invoice. How high the effective income of doctors will be, depending very much on the future height of the tax point values. However, it is no coincidence that the referral income means nothing. Very simple: if the tax point values ​​are higher than expected, a doctor with a private practice working full-time is fully utilized and can earn an average of one minute per minute earning an actual income of 196,000 francs plus National Insurance contributions. This size has been confirmed by FMH and Curafutura. However, insurers retained the right to put the issue of reference income at the end of the overall assessment of the tariff at the end of the discussion.

To make matters worse, important players are not on the board. The Health Insurance Association is larger Santésuisse Was not involved in negotiations, and the "CP" Left last September, despite the fact that its representatives agreed to the structure of the new service. Association brings strategic reasons: it considers it useless to submit a new tariff without Santésuisse. Hospitals want to start over. The existing tariff organization SwissDRG will now also be active in the field of outpatient care. There, the hospitals hope, all the partners will be present, and now the cantons. If it works, there is no schedule.

(Eds. Tamedia)

Created: 13.11.2018, 22:13

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