Tardoc under pressure: what invoice criticism reveals

The criticism is pointed: a system that tempts people to cheat is not a good system. The trigger is an investigation by the French-speaking Swiss programme «À bon entendeur», reported on by Medinside. Among other things, it describes the case of a patient who received two eye injections at separate appointments, although this had previously been done in a single consultation. The clinic justified the split with medical considerations such as infection risk and monitoring for possible side effects. According to the report, the patient's general practitioner did not share this assessment. A Council of States member from Neuchâtel described certain practices as illegal, while a specialist physician conversely criticised cuts in remuneration and wrong incentives.

The case is relevant because it touches on a central question of any tariff reform: does the way providers are paid change the course of treatment? Even so, it would be wrong to infer fraud or a nationwide practice from a single example. Whether an additional appointment is medically justified and correctly billed can only be judged on the basis of the specific case, the documentation and the tariff rules in force. The investigation provides grounds for scrutiny – not robust evidence of widespread misconduct.

What has changed since January

Since 1 January 2026, the outpatient sector has not simply been governed by «the Tardoc», but by an overall tariff system made up of two parts. Tardoc is a fee-for-service tariff: medical services as well as infrastructure and staff services are assigned tax points, which are converted into francs using canton-specific point values. Alongside it stand outpatient flat rates. They remunerate certain standardisable treatments with a fixed amount or a fixed number of tax points.

This combination is deliberate. With it, the Federal Council wanted to replace the TARMED structure, which is more than twenty years old, and correct wrong incentives. The Federal Office of Public Health itself notes that flat rates can reduce the incentive for inflated invoices that fee-for-service tariffs can create. But that does not mean every fee-for-service invoice is suspect. It remains necessary for many outpatient treatments, especially when services are less standardised or do not fall under a flat rate.

Where the critical interface lies

The difficult questions arise precisely at this interface. If certain services may not be billed together, or not in the same way, economic pressure can emerge to change workflows. Whether this actually happens in a given case must not be presumed but must be examined. Medical reasons can justify separate appointments. Conversely, splitting appointments solely to increase remuneration would be problematic. Careful auditing must distinguish between the two possibilities.