Outpatient treatment: what does it mean and who pays?
A distinction is made between inpatient and outpatient medical treatment. Comparis explains what is meant by outpatient treatment and how the costs are covered.
29.07.2022
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1. Outpatient treatment explained in simple terms
Unlike those undergoing inpatient treatment, outpatients do not stay in hospital overnight. In other words, outpatients can return home on the same day.
Examples of outpatient treatment
Visits to the doctor
Treatment by a physiotherapist, occupational therapist or speech therapist
Minor gynaecological procedures
Nutrition and diabetes advice
Treatment by nurses
Laboratory tests
X-ray examinations
2. Outpatient treatment: what costs are covered?
If the outpatient treatment was prescribed by a doctor and is listed as a compulsory benefit in the Health Insurance Act, basic insurance will cover the cost of the treatment minus out-of-pocket expenses.
Supplemental insurance includes additional outpatient benefits that are not covered by basic insurance. Check your policy conditions to find out whether your insurer will pay for the treatment.
3. What is the "outpatient before inpatient" concept?
Doctors in Switzerland perform more inpatient operations than is the case in other countries. The Federal Department of Home Affairs (FDHA) therefore decided to introduce measures to promote outpatient services. It describes the initiative as "outpatient before inpatient".
Basic insurance will now cover the cost of six groups of operations only if they are carried out on an outpatient basis (Appendix 1a of the Health Insurance Benefits Ordinance (KLV/OPAS)) (in German, French and Italian only). Exceptions are made for special circumstances requiring inpatient treatment. If your particular circumstance is not one of the exceptions, you must obtain approval of assumption of costs from your health insurer.
Examples of treatments that are only covered on an outpatient basis:
Varicose vein stripping (surgical removal of varicose veins)
Arthroscopy of the knee (to examine the knee joint)
Tonsillotomy without adenoidectomy (removal of the palatal tonsils without removal of the pharyngeal tonsils (adenoids))
4. Which operations and treatments are suitable for being performed in an outpatient setting?
In principle, any treatment that does not require intensive follow-up medical care can be carried out on an outpatient basis. These can be minor health problems such as the flu.
Outpatient procedures are particularly useful for minor or straightforward operations. However, your doctor will usually decide whether the procedure should be performed in an inpatient or outpatient setting. Find a doctor now.