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Old 13.05.2015, 11:12
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Tarmed, is it just a rip off?

Really what is the point of the Tarmed system? As much as I love Switzerland I hate visiting the doctor because it just feels an utter ripoff, every small appointment gets padded out with Tarmed items with minimum charge of 5 mins each. First 5 mins, subsequent 5 mins, general discussion, 5 mins, specific discussion 5 mins, diagnostic discussion 5 mins. So a 10 minute visit gets billed for 25 mins. And thats not even including billing for meds I didn't receive and and emergency appointment that wasn't (queried and cancelled)

I don't even think the doctors are so great. When I first came here I was amazed at the facilities but gradually I've come to realise that as diagnosticians the doctors aren't much good. My latest experience was typical, presenting with gout wanting gout meds, the big toe looks gouty, I've got a history of gout, I've had to visit the doc for gout before, I didn't fall or injure it. So the doc wants to have an xray before giving the gout meds, FFS a blood test is gout 101 but hey, it's not as expensive as an X-ray.

Yes I know I am ranting, you should have seen it before I deleted all the sweary words, now to get a new keyboard.
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Old 13.05.2015, 11:29
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Re: Tarmed, is it just a rip off?

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Really what is the point of the Tarmed system? As much as I love Switzerland I hate visiting the doctor because it just feels an utter ripoff, every small appointment gets padded out with Tarmed items with minimum charge of 5 mins each. First 5 mins, subsequent 5 mins, general discussion, 5 mins, specific discussion 5 mins, diagnostic discussion 5 mins. So a 10 minute visit gets billed for 25 mins. And thats not even including billing for meds I didn't receive and and emergency appointment that wasn't (queried and cancelled)

I don't even think the doctors are so great. When I first came here I was amazed at the facilities but gradually I've come to realise that as diagnosticians the doctors aren't much good. My latest experience was typical, presenting with gout wanting gout meds, the big toe looks gouty, I've got a history of gout, I've had to visit the doc for gout before, I didn't fall or injure it. So the doc wants to have an xray before giving the gout meds, FFS a blood test is gout 101 but hey, it's not as expensive as an X-ray.

Yes I know I am ranting, you should have seen it before I deleted all the sweary words, now to get a new keyboard.
I was always amazed how cheap going to the Dr is in CH.
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Old 13.05.2015, 11:52
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Re: Tarmed, is it just a rip off?

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FFS a blood test is gout 101 but hey, it's not as expensive as an X-ray.
Did you check Tarmed? http://www.tarmedsuisse.ch/pdf-tarifbrowser.html
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Old 13.05.2015, 12:01
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Re: Tarmed, is it just a rip off?

No, I was having a rant.

I think that 2000+ page document speaks to the over-complex nature of the system
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Old 13.05.2015, 12:06
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Re: Tarmed, is it just a rip off?

Having experienced the health system in 4 different countries, I am very impressed with the one here.

But I am lucky, I have a wonderful GP and he recommends me to the best specialists. He also listens and doesn't stick just with numbers in blood results, etc.

Only good words and very satisfied customer here.
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Old 13.05.2015, 12:16
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Re: Tarmed, is it just a rip off?

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I think that 2000+ page document speaks to the over-complex nature of the system
You never had really contact with medical billing, did you? Such documents exists in other countries as well. Some times each insurance company has its own, or even several versions. Depending on your insurance plan, contracting hospital etc. And maybe it is longer or if you have bad luck shorter than the Swiss version. "Oops, sorry we do not cover this treatment. Not in the plan."

So here is the beauty of it: The Tarmed is rather comprehensive, it applies to all insurance companies, and covers everything which is covered by basic insurance. No question asked. The draw back, it takes a rather long time to revise it and adjust prices to current practice and standards.

Edit: And you actually find the answer if the blood test or the X-Ray is more expensive. Not just guessing or random billing by your doctor.
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Old 13.05.2015, 13:27
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Re: Tarmed, is it just a rip off?

I'm guilty of moaning about the quality of care I have access to here, but one thing I can't complain about is the cost. Medical care in Switzerland is actually quite reasonable.

When frustrated by the local GP's... shall we say... lack of the level of knowledge I would expect from someone with a medical degree, I went home to the US for diagnosis. Outstanding treatment back home - but good thing the problem wasn't an arm and a leg, because that's what I had to pay. Out of pocket.

Yes, the Swiss health care system has it's problems. But at least it won't end up bankrupting you.
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Old 13.05.2015, 14:44
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Re: Tarmed, is it just a rip off?

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When frustrated by the local GP's... shall we say... lack of the level of knowledge I would expect from someone with a medical degree, I went home to the US for diagnosis.
So find a new GP.

I had a village GP here whom I still maintain is a bad doctor who isn't attentive and is afraid to treat things. When I moved to the city, I asked friends for recommendations and ended up with a very good doc who takes the time to make sure you feel taken care of, and refers to appropriate specialists as needed.
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Old 13.05.2015, 14:49
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Re: Tarmed, is it just a rip off?

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Really what is the point of the Tarmed system? As much as I love Switzerland I hate visiting the doctor because it just feels an utter ripoff, every small appointment gets padded out with Tarmed items with minimum charge of 5 mins each.
Tarmed is simple enough that (as others in this discussion have shown) normal people can browse it. Wanna see a true clusterf**k of a medical billing system? Look at USA.

As for what the point is: One of the key elements of keeping medical costs down is accurate billing, and that means knowing what exactly the time has been spent on. You seem to think that a bill that says only "DOCTOR VISIT - FR. 284.33" would be better. But obviously such a system would simply invite fraud.

If you see what you believe to be billing errors on the part of your doctor, then raise the issue with the doctor – that's not an inherent fault in the system.
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Old 13.05.2015, 14:53
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Re: Tarmed, is it just a rip off?

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So find a new GP.

When I moved to the city,
Aya, there's the rub.

When I first looked for a doc out here in the boondocks, there was only one GP in the area accepting new patients. And I soon learned why... The only reason I now have a sort of decent GP is that a new practice opened in a neighboring town and I called the day the phones were installed.

We are definitely feeling the shortage of GPs in the villages out here.
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Old 13.05.2015, 19:55
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Re: Tarmed, is it just a rip off?

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Really what is the point of the Tarmed system? As much as I love Switzerland I hate visiting the doctor because it just feels an utter ripoff, every small appointment gets padded out with Tarmed items with minimum charge of 5 mins each. First 5 mins, subsequent 5 mins, general discussion, 5 mins, specific discussion 5 mins, diagnostic discussion 5 mins. So a 10 minute visit gets billed for 25 mins. And thats not even including billing for meds I didn't receive and and emergency appointment that wasn't (queried and cancelled)

I don't even think the doctors are so great. When I first came here I was amazed at the facilities but gradually I've come to realise that as diagnosticians the doctors aren't much good. My latest experience was typical, presenting with gout wanting gout meds, the big toe looks gouty, I've got a history of gout, I've had to visit the doc for gout before, I didn't fall or injure it. So the doc wants to have an xray before giving the gout meds, FFS a blood test is gout 101 but hey, it's not as expensive as an X-ray.

Yes I know I am ranting, you should have seen it before I deleted all the sweary words, now to get a new keyboard.
If you're not happy, go question the bill and make the Doctor justify everything, i've done it and it is nice to see them squirm in embarrassment.

Once he's admitted he over charges and will make amends, wait for the new bill, then tell him the bill is for his account and any noise, you'll send both to assurance company and to Office Federal Sante and start proceedings for fraud.

Works a treat and he'll never give you a bullshit bill again

(not adsvised if you frequently need to visit doctor, though )
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Old 13.05.2015, 20:26
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Re: Tarmed, is it just a rip off?

My GP in England: "Have a couple of Paracetamols and a cup of tea, luv, it's good for the morale"


My GP in CH: "Have a couple of Paracetamols and a glass of red wine, it's good for your heart."


I have adapted quite well to the Swiss medical system!
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Old 15.05.2015, 12:55
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Re: Tarmed, is it just a rip off?

Hmm, nope I just don't see anything except an invitation to overcharge, I would actually be happier with a bill that was just 'doctors time x' 'drugs y'. My main objection is that Tarmed guarantees overcharging for time. As mentioned above, a 10 minute appointment invariably has 25 mins of time billed due to the billing granularity of 5mins. I did query that and got a swiss shrug, and 'Thats how its done here' accompanied by the implication that if I don't shut up all future appointments will result in a barium enema. Ok I made up the enema bit.

As an analogy, it seems to me it's like going to the garage to get a new alternator, instead of paying for half an hour of the mechanics time and a new alternator, you end up paying for a couple of hours because of elements like
Locating alternator, 5 mins
Unscrewing bolt x 4, min 5 mins
Hitting with hammer small, min 5 mins
Hitting with hammer large, min 5 mins
Unpacking new alternator, min 5 mins
etc etc

On the subject of reasonable charges, what is reasonable?, from memory the lowest I think I've had for a docs appt is about 80 chuffs for a quick in an out for a prescription, if there is actually any laying on of hands then it'll be north of 150.

The tarmed bill explained at http://www.aerztekasse.ch/de/cm_data...D_E_280905.pdf
would be a dream, 40 chuffs for 15 mins, I should coco.
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Old 15.05.2015, 13:29
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Re: Tarmed, is it just a rip off?

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On the subject of reasonable charges, what is reasonable?

Our ideas of what is reasonable are shaped by our experiences elsewhere.

Coming from US healthcare, any time I walk out with a bill under four figures I consider that reasonable.

A prime example: Late one night OH started having chest pains. Trip to the ER, cardiologist called in, all the machines, monitoring, etc. Total bill: CHF 800. Not just our franchise, that was the total bill.

An ER visit for a suspected heart attack would cost many, many times that in the US. (And then I'd likely end up fighting with a US insurer.) So you can see why I have no complaints over Swiss health care prices.




Now if we could just find a way to get more doctors, better doctors, interested in general practice...
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Old 15.05.2015, 13:38
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Re: Tarmed, is it just a rip off?

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Our ideas of what is reasonable are shaped by our experiences elsewhere.

<snip>
...
Well I'm more wondering whats reasonable for a consultation with the GP. I think any sort of emergency scenario is going to cost, although 800 for that experience would have been a pleasant surprise.
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Old 15.05.2015, 13:45
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Re: Tarmed, is it just a rip off?

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Well I'm more wondering whats reasonable for a consultation with the GP.
I usually expect something in the 200s for a GP visit. That would usually include a ca. half hour consultation, in-house blood test, BP measurement, etc. Sometimes I am pleasantly surprised and it turns out a bit less.

I do like that the GP can take his/her time with you in consultation. In the US I've learned to ask upfront whether the doctor is limited to 6 or 9 minutes, and then talk very very fast.
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Old 15.05.2015, 14:52
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Re: Tarmed, is it just a rip off?

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We are definitely feeling the shortage of GPs in the villages out here.
Not around here, we have two in a village of 1800.

Tom
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Old 15.05.2015, 18:21
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Re: Tarmed, is it just a rip off?

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Now if we could just find a way to get more doctors, better doctors, interested in general practice...
Yep, that's a tough one. It's also why we choose to live where we do - we have access to all the docs we need.
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Old 15.05.2015, 22:57
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Re: Tarmed, is it just a rip off?

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Now if we could just find a way to get more doctors, better doctors, interested in general practice...
Husband still living, they can't be so bad
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Old 15.05.2015, 23:41
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Re: Tarmed, is it just a rip off?

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Husband still living, they can't be so bad
Thanks to the cardiologist at the ER, no GPs involved.

The crisis is in general practice, not specialities. The best and the brightest do not want to become GPs anymore - and those that do want to go into general practice don't much fancy the boondocks.

A shame, because the GP needs to be the point person, he/she is only one in the chain who sees the patient as a whole person and not just a collection of discrete organs. We need our best and brightest in general medicine.
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