TARMED (from the French tarif médical) is the tariff structure for charging outpatient medical services in Switzerland that has been in force since 2004. The tariff structure is used exclusively for the remuneration of outpatient medical services and was introduced with the aim of standardising the previously different cantonal medical tariffs. TARMED is a so-called fee-for-service tariff, i.e. each service is billed individually. TARMED was developed by the FMH together with the accident and health insurers and the hospitals.
Structure and functioning of TARMED
Each service in the outpatient medical sector is assigned a certain number of tax points depending on the time required, the difficulty and the infrastructure required. This number of tax points is specified by the TARMED tariff structure and is thus the same throughout Switzerland. TARMED now comprises more than 4,600 fee-for-service items.
TARMED distinguishes between medical and technical services.
Often, the various service items in TARMED require certain professional qualifications (such as specialist titles, specialisations or certificates of competence). This so-called qualitative dignity is necessary in order to be able to charge these services to social insurance. In addition to the medical services, certain technical services are billed separately (e.g. medicines, laboratory analyses or medical devices).
After determining the sum of the tax points according to TARMED, these are multiplied by the cantonally different tax point values (in CHF). The result represents the total amount of reimbursement for the medical service. The tax point values are determined in each canton by the tariff partners and approved by the cantonal authorities, or fixed in the absence of agreement.
Accordingly, identical services can be reimbursed differently from canton to canton and/or depending on the insurance company. These differences can be explained, among other things, by the different cantonal incomes, cost structures or the density of doctors. In general, the tax point values are on average around CHF 0.90.
Other tariffs used by doctors in addition to TARMED, such as the Analysis List (AL) or the Medium and Object List (MiGeL), are official tariffs and are drawn up by the Federal Office of Public Health. Both TARMED and the official tariffs must be submitted to the Federal Council for review and approval.
TARMED revisions and future prospects
Since the introduction of the first TARMED version 1.1 in 2004, the tariff partners have repeatedly adjusted individual positions or tax points of TARMED and submitted them to the Federal Council for approval. However, the tariff structure has never been revised as a whole.
Since 2013, the Federal Council has had the authority to adjust the structure of TARMED if it is no longer appropriate and/or the tariff partners cannot reach agreement. Based on this, the Federal Council has made use of its subsidiary competence twice so far. In 2014 and 2017, it intervened with an adjustment to TARMED.
At the same time, costs in doctors’ practices and in the outpatient departments of hospitals have risen steadily since the introduction of TARMED in 2004. There are many different triggers for this cost increase, which are weighted differently depending on the observer. It is generally accepted that TARMED is outdated due to the lack of an overall revision. As a result, the tariff structure also no longer manages to correctly reflect business and medical reality. For example, TARMED is based on a cost model from the 1990s. Some procedures require less time today than when TARMED was introduced in 2004. Accordingly, such treatments are reimbursed too highly, while other services are reimbursed too low or certain services are even missing altogether.
Due to the dissatisfying situation, there have been various efforts for several years to replace TARMED as the outpatient tariff system. With the development of a new fee-for-service tariff, the TARDOC, and the development of the outpatient flat rates, a successful renewal of the outpatient tariff structures now finally seems to be imminent. As of 01.01.2025, TARMED should be replaced by these two tariffs. You can find out more about the current developments in the tariff system on the following page: