Outpatient treatment

What is outpatient treatment?

Outpatient treatment is an examination or therapy after which you go home again. You are not admitted to hospital overnight. It includes an appointment at your GP’s practice, having blood taken at a laboratory, physiotherapy and a check-up with an ophthalmologist, but also many operations, for example on the knee, hand or eye, if you are discharged the same day.

The law defines outpatient treatment by its opposite. Art. 5 of the Ordinance on Cost Calculation and Service Recording in Health Insurance (VKL) states: all treatments that are not inpatient treatments are outpatient treatments. Repeated stays in day or night clinics expressly count as outpatient. Inpatient treatment, by contrast, is a stay of at least 24 hours or a shorter stay during which you occupy a bed overnight (Art. 3 VKL).

Outpatient services are not only provided by doctors. Physiotherapy, occupational therapy, nutritional advice, Spitex, pharmacies and laboratories also work on an outpatient basis, provided they are licensed for basic health insurance. Whether a treatment takes place as an outpatient treatment in a hospital or in a practice makes no difference to the classification: an outpatient consultation in hospital is just as much outpatient treatment as a visit to your GP.

How it works

Free choice: In basic health insurance, you choose freely for outpatient treatment among the licensed service providers that are suitable for your illness. The insurer pays according to the tariff that applies to the service provider you choose (Art. 41 para. 1 KVG). If you have a GP, HMO or Telmed model, you have voluntarily restricted this choice: you must then contact the agreed point of contact first (Art. 41 para. 4 KVG).

Billing: Outpatient services are billed according to tariffs (Art. 43 KVG). A tariff can value individual services with tax points or provide for a flat rate per treatment. Since 01.01.2026, the fee-for-service tariff TARDOC has applied to medical services, supplemented by outpatient flat rates for certain procedures. They replace the former TARMED tariff.

Financing: Today, the costs of outpatient treatment are borne by the health insurer alone, in other words through premiums. The canton only contributes to inpatient treatment (Art. 49a KVG). This difference will change with uniform financing (EFAS): according to the FOPH, outpatient and inpatient services will be financed in the same way from 2028, with the cantons then covering 26.9% of net costs.

Your co-payment: On outpatient invoices, you pay the deductible and then a 10% retention fee, up to a maximum of CHF 700 a year for adults and CHF 350 for children (Art. 64 KVG, Art. 103 KVV). You do not pay a hospital contribution for outpatient treatment.

Legal basis

Art. 25 para. 2 let. a of the Federal Health Insurance Act (KVG) expressly includes examinations and treatments provided on an outpatient basis among the compulsory benefits of basic health insurance. Art. 41 para. 1 KVG gives you a free choice among licensed service providers for outpatient treatment; para. 4 allows you to restrict this choice in return for a lower premium.

Art. 43 KVG governs tariffs: fee-for-service tariffs and outpatient flat rates per patient must be based on a uniform tariff structure for the whole of Switzerland (para. 5). If there is an approved flat-rate structure, all service providers must apply it to the treatments concerned (para. 5ter). Art. 5 VKL defines outpatient treatment as everything that is not inpatient treatment.

Art. 3c of the Health Care Benefits Ordinance (KLV) implements the principle of “outpatient before inpatient”: for the planned procedures listed in Annex 1a KLV, basic health insurance only pays for an inpatient stay if carrying out the procedure on an outpatient basis is not appropriate or not cost-effective because of special circumstances. You can find out more under outpatient before inpatient.

Example: a year of outpatient invoices

Nina is 29, has a CHF 1,000 deductible and a GP model. In one year, she only has outpatient invoices. The amounts are assumed; the deductible, retention fee and maximum amount are the statutory values.

What this means for you

Most healthcare costs arise on an outpatient basis: in practices, pharmacies, laboratories and therapies. That is why your deductible has its main effect here. If you regularly need outpatient treatment, you will reach your deductible almost every year. A low deductible is then often cheaper. Work it out with your premiums in the premium calculator.

• Check your model. With a GP, HMO or Telmed model, you pay a lower premium but go to the agreed point of contact first for outpatient treatment. You can see which insurers offer which models under health insurers.
• Submit all invoices. Even small invoices count towards your deductible.
• Ask before an operation. If a procedure is carried out on an outpatient basis, you save the hospital contribution. Whether outpatient treatment is possible is decided by the doctor on medical criteria.
• Remember the deadlines. If you want to lower your deductible because of planned treatment, your notification must reach the insurer by 30 November. Details under deadlines.

Common mistakes

• Confusing outpatient with “not insured”. Outpatient treatment is fully part of basic health insurance. Supplementary outpatient insurance only adds benefits that the KVG does not cover.
• Thinking the emergency department means inpatient treatment. If you go home after treatment, it is outpatient treatment, even in hospital.
• Forgetting your model. If you are in the GP model and go straight to a specialist, you risk your insurer not paying the bill.
• Misclassifying a day clinic. Under Art. 5 VKL, repeated stays in day or night clinics count as outpatient treatment, even if they go on for weeks.

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