The revision of the KVG was aimed in particular at containing costs and increasing the quality and efficiency of service providers. The latter resulted in new provisions for the billing of outpatient services provided at the expense of the CHI in Switzerland from January 1, 2022. With Art. 37 Para. 1bis KVG, the cantons are now authorized to introduce an exception provision.
Revision of the KVG as of January 1, 2022
Art. 37 para. 1 KVG stipulates, among other things, that physicians must have worked for at least three years in the requested specialty at a recognized Swiss training center in order to be allowed to work as a service provider at the expense of the OKP. The provision applies to all active physicians who were not yet allowed to bill the OKP by January 1, 2022. The revised KVG thus places more stringent requirements on physicians who wish to bill the CHI.
This particularly affects foreign doctors or outpatient institutions that employ them. As a result of the amendment, it is currently impossible for foreign doctors - regardless of whether they have a recognized specialist title - to work immediately at the expense of the CHI. This applies to both self-employed doctors and employees of an outpatient medical institution. Until now, Art. 37 KVG required without exception that all physicians have worked for at least three years in the requested specialty at a recognized training center in Switzerland if they wanted to bill the CHI.
New exceptions concerning the admission requirements for individual fields of study
Already in May 2022, i.e. only 5 months after the entry into force of Art. 37 KVG, various cantons and other institutions expressed their criticism regarding the admission requirements. In this context, it was noted in particular that the requirement is in contradiction to the current Agreement on the Free Movement of Persons and leads to underprovision. The distinction between outpatient and inpatient service providers also showed that the requirement did not pursue the goal of quality assurance.
The federal parliament considered this criticism justified and took legislative action.Art. 37 para. 1bis KVG, which entered into force on March 17, 2023, stipulates that the cantons may provide for an exemption from the requirement of three years of activity at a Swiss postgraduate training center for the following specialties if there is an undersupply in the cantonal territory in the areas concerned: General internal medicine (as the only continuing education title); general practitioner (as the only continuing education title); pediatrics and adolescent medicine; and child and adolescent psychiatry and psychotherapy.
Due to the optional provision, this is an authorization of the cantons at the federal level. In order to be able to make use of it as an affected person, a concrete implementation by the affected canton is required first. It is generally known that some cantons are already dealing with the implementation of this provision.
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