Inpatient treatment

What is inpatient treatment?

Inpatient treatment is treatment for which you are admitted to a hospital or birth centre and stay overnight. The counterpart is outpatient treatment, after which you go home on the same day. The distinction matters in health insurance because the two areas are billed and financed differently.

The exact boundary is drawn by Art. 3 of the Ordinance on Cost Calculation and Service Recording in Health Insurance (VKL). Stays for examination, treatment and care count as inpatient

• if they last at least 24 hours,
• if they last less than 24 hours but you occupy a bed overnight,
• in the case of a transfer to another hospital or from a birth centre to a hospital,
• in the event of death.

Everything else is outpatient (Art. 5 VKL). Repeated stays in day or night clinics also count as outpatient.

In basic health insurance under the Federal Health Insurance Act (KVG), you are insured for inpatient treatment in the general ward of a listed hospital. The semi-private and private wards are not included; supplementary hospital insurance under the Insurance Contract Act (ICA) exists for those. A stay in a nursing home, which is financed under its own rules, must be distinguished from an inpatient hospital stay.

How it works

Choice of hospital: you may choose freely among the hospitals on the Hospital List of your canton of residence or of the canton where the hospital is located (listed hospitals). However, basic health insurance and your canton of residence pay at most the tariff that applies to the same treatment in a listed hospital in your canton of residence (Art. 41 para. 1bis KVG). If you have to go to another hospital for medical reasons, for example in an emergency or if the treatment is not offered in your canton of residence, the insurer and the canton still cover the costs in their respective shares.

Billing: hospitals bill inpatient treatment using flat rates, as a rule flat rates per case (Art. 49 para. 1 KVG). In acute somatic care, this is the SwissDRG tariff structure. The flat rate covers treatment, accommodation and care. It settles all of the hospital’s claims for services under the KVG.

Financing: today, two payers share the flat rate. The canton of residence covers at least 55%, the health insurer the rest (Art. 49a KVG). Each canton sets its share no later than nine months before the start of the calendar year. The canton pays its share directly to the hospital. Outpatient treatment, on the other hand, is currently paid for by the health insurer alone.

Your co-payment: on the health insurer’s share, you pay the deductible and a 10% retention fee up to a maximum of CHF 700 per year. On top of that comes the hospital contribution of CHF 15 per day, excluding the day of discharge. Children, young adults in education and women during maternity are exempt from the hospital contribution.

Outpatient before inpatient: for certain planned procedures, basic health insurance only pays for an inpatient stay if performing the procedure on an outpatient basis is not appropriate or not cost-effective because of special circumstances (Art. 3c KLV). The list of these procedures is set out in Annex 1a to the KLV, published by the FOPH.

Legal basis

Art. 25 para. 2 let. a and e KVG include among the compulsory benefits examinations and treatment provided on an inpatient basis, and the hospital stay in line with the standard of the general ward. Art. 41 para. 1bis KVG governs the free choice among listed hospitals and limits remuneration to the tariff of the canton of residence; Art. 41 para. 3 KVG governs the exception for medical reasons.

Art. 49 para. 1 KVG requires flat rates for inpatient treatment, based on uniform structures for the whole of Switzerland. Art. 49a KVG divides the costs between the canton and the insurer: para. 2ter requires a cantonal share of at least 55%, para. 3 governs payment directly to the hospital. The terms inpatient and outpatient are defined in Art. 3 and Art. 5 VKL.

On 24 November 2024, voters approved an amendment to the KVG on uniform financing (EFAS). According to the FOPH, outpatient and inpatient services will be financed in the same way from 2028: the cantons will then pay 26.9% of the net costs to the insurers, and 73.1% will be financed through premiums. Until the amendment enters into force, the current split applies.

Example: three nights in a listed hospital

Sandra is 52, lives in the canton of Bern and has the standard deductible of CHF 300. She has a planned procedure in a listed hospital in her canton and stays three nights. Assume the flat rate per case is CHF 10,000 and the canton bears the statutory minimum share of 55%.

The figures for the flat rate are assumptions, because every flat rate per case depends on the diagnosis, the procedure and the hospital’s base rate. The deductible, retention fee, hospital contribution and the canton’s minimum share are the statutory values.

What this means for you

• Plan procedures with your deductible in mind. If an operation is due next year, use the premium calculator to work out whether a lower deductible is cheaper. The change must reach your insurer by 30 November, see deadlines.
• Clarify your choice of hospital beforehand. If you want to go to a hospital outside your canton, ask your insurer whether the tariff there is higher than in your canton of residence. Otherwise you bear the difference yourself.
• Check whether you need supplementary hospital insurance. Basic health insurance fully covers the general ward. Supplementary insurance pays for comfort, room and choice of doctor, not for the medical treatment itself. You can see which insurers offer which products in the health insurers overview.
• Read the statement of benefits. Check the days of your stay and the hospital contribution. The day of discharge may not be charged.

Common mistakes

• Thinking every night in hospital means inpatient. The reverse also applies: a long day in hospital without an overnight stay is outpatient. Art. 3 VKL is decisive.
• Believing the canton also pays for outpatient care. Today, the canton only bears inpatient costs. Outpatient treatment is paid for by the insurer alone until EFAS applies.
• Forgetting the hospital contribution. It comes on top of the deductible and retention fee and has no cap.
• Choosing a hospital that is not on a list. If a hospital is not on any Hospital List, basic health insurance only pays if the insurer has a contract with it, and then at most its own share. In this case, the canton pays nothing.

We explain how we build examples and calculators under How we calculate.