Tarmed tariff system in Switzerland: what is it?
Doctors in Switzerland generally bill their work via the Tarmed tariff system. How does Tarmed work, and what other tariff systems are there? Get an overview here.
18.08.2022
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1. What is the Tarmed tariff system?
The Tarmed tariff system determines how much money doctors are allowed to charge for their work. Tarmed is valid throughout Switzerland. It applies to both outpatient medical services in medical practices as well as in hospitals.
2. How does Tarmed work?
Under the Tarmed system, medical services are allocated a certain number of tariff points. The time required, the complexity and the required infrastructure are the determining factors. Tariff points are uniformly regulated throughout Switzerland.
Tariff point values indicate the fee for a tariff point. They are regulated at the cantonal level. Therefore, tariff point values can vary by canton.
Good to know: each service has its own number, known as a tariff number.
How billing works with Tarmed
Tariff points × tariff point value = treatment costs
3. Overview of tariff types: what tariffs are there?
Pursuant to the Health Insurance Act (Art. 43), doctors and other service providers may use three types of tariffs to bill for their work (only in German, French and Italian):
Individual service tariff
Time-based fees
Flat-rate
What is an individual service tariff?
With the individual service tariff, the service provider invoices the insured person for each individual service. It must be based on the Tarmed tariff structure.
Example: doctors charge the first five minutes of a basic consultation via the individual service tariff (tariff number 00.0010).
What is a time-based fee?
This tariff is based on the amount of time required for the medical treatment or care. It is mainly used for nursing care.
Example: in Zurich, Spitex basic care costs 52.60 francs per hour.
What is a flat rate?
Under this system, health insurers and service providers agree on a flat rate for the treatment. This tariff is mainly used for inpatient treatment in hospitals.
Depending on the hospital, the flat rate may vary. This is because health insurance companies negotiate flat rates with each hospital individually. The Conference of Cantonal Health Directors provides an overview list of the tariffs (only in German and French).
Health insurance companies check whether the services invoiced are necessary for treatment. This is because according to the Health Insurance Act, basic insurance services that are effective, appropriate and cost-efficient. Obviously incorrect items are rejected by the health insurer.
However, even if a doctor provides non-necessary services, the health insurance company will still pay in some cases. This is because it is often difficult to prove afterwards whether medical treatment was necessary or not.
