"New flat rates set the wrong incentives" Doctors are now warning of drastic consequences for patients

From 2026, outpatient treatment in Switzerland is to be increasingly reimbursed on a flat-rate basis. While hospitals welcome the reform, medical specialists warn of negative consequences for patient care

In Switzerland, a planned reform of the tariff system for outpatient treatment is causing fierce debate. From 2026, many services will no longer be reimbursed on a time and material basis, but on a flat-rate basis. Andreas Arnold, an ENT specialist in Münsingen, warns of the consequences in the NZZ am Sonntag newspaper: "The new flat rates create the wrong incentives. Doctors will be forced to make decisions for cost reasons that are not always in the interests of patients."

The reform combines elements of the previous Tarmed system, which charges for every procedure, with flat rates, as are already used in the inpatient sector. Smaller practices in particular could suffer as they would have to bear the costs of additional expenses such as laboratory analyses themselves. "At the end of the day, we have to pay the salaries of our employees, which becomes more difficult with these flat rates," says Arnold. In future, procedures with unclear cost consequences would be more likely to be referred to hospitals, which could place an additional burden on them.

Other specialties also criticize the flat rates. Nuclear medicine specialist Michael Messerli fears drastic cuts in remuneration for important examinations in cancer and heart diagnostics. Hand surgeon Torsten Franz warns that additional expenses, such as the stiffening of several fingers, would not be covered. "This is inefficient and burdens patients with multiple necessary procedures," Franz explains to NZZ am Sonntag

Small practices are struggling

Supporters of the reform, including the hospital association H+, argue that the flat rates are administratively more efficient and are based on real performance data. "Larger hospitals can absorb the financial shifts better than small practices," admits Anne-Geneviève Bütikofer, Director of the hospital association. The Federal Office of Public Health has announced that the system will be reviewed and adjusted annually after its introduction. However, many doctors are skeptical about this prospect.

Arnold's practice shows how important thorough diagnostics are. A patient in whom Arnold detected a tumor at an early stage thanks to a tissue sample sent in is sitting in his treatment chair. "Everything's fine," says the doctor with relief. But the question remains as to whether he will still be able to offer such examinations in future without financial disadvantages.