Submitted text
How does the Federal Council justify the fact that Tardoc requires service providers to breach their duty of medical confidentiality towards their patients if they wish to have their invoices reimbursed by the basic insurers?
Justification
The new Tardoc medical tariff, which has applied since January 1, 2026 for the remuneration of service providers for outpatient treatment at the expense of the OKP, the ICD-10 code (International Statistical Classification of Diseases – 10th Revision) must be indicated on the invoice must be entered. If the code is missing, the insurer will refuse to cover the costs. The ICD-10 codes are by no means confidential; they can be deciphered and show the diagnoses on which the doctor’s visit is based. In this way, the insurer – and above all the administrative staff who receive and distribute the mail – are informed of the reason for the consultation. With Tarmed, the code did not have to be specified; the change was made secretly and without democratic legitimation. Is the Federal Council aware of this? What does it intend to do to protect medical confidentiality, which is essential for the relationship of trust between patients and healthcare professionals?
Statement of the Federal Council of 22.4.26
The Federal Council is aware of the importance of the relationship of trust that exists between patients and their doctors and believes that the disclosure of medical data must be subject to strict rules.
According to Article 42 paragraph 3bis of the Federal Health Insurance Act (KVG; SR 832.10), service providers must list the diagnoses and procedures required for invoicing on the invoice, coded according to recognized classifications. The obligation to state the diagnoses on the invoices is also repeated in Article 59 paragraph 1 letter c of the Ordinance on Health Insurance (KVV; SR 832.102). This provision applies regardless of the tariff model, This also applies to TARDOC and the outpatient flat rates.
The disclosure of diagnoses is therefore based on a legal obligation. It is intended to enable health insurers to check invoices, particularly with regard to the calculation of remuneration and the cost-effectiveness of services (Art. 42 para. 3 KVG). In this context, the disclosure of diagnoses on medical invoices No breach of professional secrecy within the meaning of Article 321 of the Swiss Criminal Code (SCC; SR 311.0). However, it must meet the requirements of the Federal Act on Data Protection (FADP; SR 235.1), in particular the principle of Data minimization. In the absence of a clear agreement between the tariff partners, the Federal Council defined minimum requirements in its decision of April 30, 2025, which are similar to the framework known under TARMED. The tariff partners were asked to quickly clarify whether the disclosure of detailed data would be proportionate in certain cases.
In addition, insurers are obliged to Data security to ensure compliance. The Federal Office of Public Health monitors compliance with these obligations and the Federal Data Protection and Information Commissioner is responsible for compliance with data protection law. As part of their supervisory responsibilities in the area of data protection, the two authorities coordinate their activities.