Children's hospital chief Altmann criticises the new outpatient tariffs
The head of the Eastern Swiss Children's Hospital sees the funding gap continuing to grow. The St. Gallen and Basel results show differing outcomes – and sustained pressure.
Serge Altmann, CEO of the Ostschweizer Kinderspital, criticises the funding of outpatient paediatric treatment even after the tariff change at the start of 2026. The hoped-for improvement has largely failed to materialise, he writes in a guest article published by Medinside on 4 November. Emergency care in particular remains inadequately reimbursed. Altmann warns that less money could be left for treatment, research and training.
The criticism comes from a hospital director who is directly affected. His article had already appeared in the NZZ on 28 October. It is therefore a current statement on tariff policy, not a new nationwide survey of all children's hospitals.
A profit built on 14.4 million francs in additional contributions
The latest St. Gallen financial statements show how strongly an annual result can depend on supplementary funding. The Ostschweizer Kinderspital foundation reported a profit of 1.5 million francs for 2025. At the same time it received 1.8 million francs in donations and 14.4 million francs in additional contributions from its sponsoring bodies. In May the hospital stated that these contributions offset the inadequate reflection of paediatric medicine in the tariffs, particularly in the outpatient sector.
A positive result therefore does not prove that treatment revenues alone cover all costs. Conversely, one cannot simply deduct donations and sponsoring contributions from the profit and label the outcome an operating loss without further examination. That would require taking account of the line items and deferrals in the full accounts.
Basel stays in the red despite more services
The Universitäts-Kinderspital beider Basel, UKBB for short, reported a company result of minus 5.9 million francs for 2025. It nevertheless described the result as significantly better than budgeted and attributed this to higher productivity and improved processes. Structural underfunding remains a burden, the hospital stated in May.
The UKBB treated 6305 inpatients and recorded 126 065 outpatient visits. The latter rose by a good six per cent compared with the previous year. More care and an improved result can therefore coincide with a continuing loss. The accounts of both hospitals relate to 2025; they do not yet measure the outcome of the 2026 tariff change.
A new structure, differing franc values
Since 1 January 2026, outpatient medical services have been billed through TARDOC or outpatient flat rates. TARDOC values individual services in tax points. Flat rates bundle the services of a single treatment. The number of tax points is then multiplied by a franc value that differs from canton to canton. This is how the Federal Office of Public Health describes the calculation.
The tariff structures apply throughout Switzerland. That does not mean, however, that every treatment in every canton brings in the same franc amount. Alongside the structure, the agreed or approved tax point value is decisive. A statement about the underfunding of a particular hospital therefore requires its costs, its range of services and its concrete reimbursement – not just the name of the tariff.
Inpatient treatment follows a different funding model. The canton of Basel-Landschaft explains that the canton of residence and the insurer share the reimbursement. Outpatient underfunding therefore does not mean that all types of treatment and all cantons are affected to the same degree.
Additional effort meets cost neutrality
Altmann justifies the higher requirements with, among other things, very different age groups, rare diseases and additional staffing needs. Even a blood sample can tie up several staff members; small children often need anaesthesia support for an MRI scan. He puts the structural deficit of the children's hospitals and paediatric clinics for 2025 at around 130 million francs. This total is his own figure in the guest article, not the result of a cantonal cost calculation disclosed there.
At the same time, the federal government requires a cost-neutral tariff change: the switch itself should not cause additional costs for the same services. According to the FOPH, this requirement must be distinguished from the later development of service volumes. If the intended growth corridor is exceeded, corrections are possible; the cost-neutrality phase runs at least until 2028.
For the children's hospitals, the task therefore remains to demonstrate their particular effort in the further development of the tariffs. The next set of accounts must show how the new reimbursement actually works out – with billing data for 2026 rather than the previous year's financial statements alone.
Sources
- FOPH: Outpatient medical tariff and cost neutrality
- Ostschweizer Kinderspital: 2025 annual financial statements
- UKBB: 2025 annual report, notice of 21 May 2026
- Canton of Basel-Landschaft: Tariffs and financing
- Serge Altmann: guest article on underfunding, Medinside, 4 November 2026
- Lead image: Re probst, UKBB Basel
- Article image: Yogabrata Chakraborty, Swiss franc coins
- Licence for both images: CC BY-SA 4.0
