Market access for medical technologies in Switzerland

Reimbursement

Reimbursement for hospital procedures is made solely via the SwissDRG system. All cases of hospitalization with at least one overnight stay are reimbursed via DRG. Day cases and outpatient care are completely separate from hospital care provisions and currently reimbursed via a fee-for-service model using the TARMED catalog. However, in 2026, the TARMED catalog is expected to be replaced by the TARDOC catalog for outpatient procedures and the outpatient flat-rates system for interventions performed in day case settings).

The DRG system has the following components:

Diagnosis-related groups

• DRGs are determined by the combination of a procedure code (CHOP) and a diagnosis code (ICD-10-GM). CHOP nomenclature is maintained by the Federal Statistics Office (BFS/UFS) and released annually
• The base rate is determined nationally, and the Cantons have to approve and adopt it. In case they do not adopt it, the Cantons may set their own base rate (rarely the case) 

Add-on reimbursement (Zusatzentgelt, ZE)

• Add-on reimbursement is provided for expensive devices, procedures, and drugs
  Tariff is typically determined on the national level by the administrator of the DRG system, SwissDRG

The SwissDRG system is approved annually.

Procedures performed in out-patient and day case settings are reimbursed via a fee-for-service mechanism via the TARMED catalog (soon to be replaced).

Specifics for IVD tests

In-vitro diagnostic tests are reimbursed using a fee-for-service mechanism via the List of Analyses (Annex 3 of the Healthcare Benefit Ordinance, KLV/OPre) in out-patient settings.