Swiss physiotherapy’s new tariff split exposes an old problem

Switzerland has managed to do what it often does when a sector feels squeezed: create a second association. Prophysio is the result of a bitter dispute over a new billing structure for physiotherapy, negotiated by Physioswiss, prio.swiss and H+. The irony is tidy enough. A system designed to bring order to costs has instead produced a fresh institutional layer, because apparently one lobby was not enough.

At the centre of the dispute is a tariff model that will shift physiotherapy towards time-based billing in five-minute increments. Under the new structure, services would be billed at CHF 1.50 per minute. That replaces the current system, which works with session flat rates and two different calculations: CHF 1.20 per minute for standard treatment and CHF 1.80 for more complex cases. The federal rule is clear, at least in the way such rules tend to be clear: the new contract must be cost-neutral. No extra money is to be added to the pot.

That has not stopped the criticism. In a survey by Sotomo among 2,800 respondents, 71 per cent rated the new tariff structure as very negative or rather negative. The survey was not representative, which is the sort of detail that always arrives after the headline has done its work. Still, the mood in the sector is plainly sour. Prophysio argues that the new model does not reflect reality and creates false incentives. Alexandra Helbling says the planned time tariff could lead to more volume, while evidence-based physiotherapy is not determined by treatment time but by the treatment itself.

The complaints are not limited to abstract principle. Prophysio also objects to the way administration is handled. In modern practices, it says, practice assistants often take care of administrative work. Under the new tariff, some of that would only be remunerated if therapists do it themselves. The tariff partners respond that nothing new is being added to the administrative burden; in their view, tasks such as reading files and exchanging information with doctors were already part of the professional role. They say these services will now simply be shown more transparently and paid correctly.

Felix Schneuwly of Comparis can understand why the split happened, at least to a point. He notes that physiotherapy practices have long felt the pressure because inflation was never compensated while costs kept rising. Yet he doubts that a solo run inside the tight framework of the KVG will achieve much. In his view, the deeper flaw is structural: the system pays for quantity, not for efficiency or quality. That is a charming arrangement if one enjoys cost debates without ever solving them.

Physioswiss, for its part, insists it remains the recognised tariff partner and represents the whole sector, with more than 12,000 members. Its communications chief, Chantal Mathys, says the association takes note of the new foundation and respects that views on union work can differ. She also warns that fragmentation would weaken the sector’s negotiating position, just as the decisive cantonal tax point value procedures are under way.

The bigger question is what this means for the health system as a whole. Schneuwly points out that other professions, such as pharmacy and medicine, also have more than one interest group, but manage not to fight their battles in public. If physiotherapy cannot do the same, he suggests, politics will eventually settle the matter. That is usually how Switzerland handles disputes once the stakeholders have exhausted themselves: the state steps in, and everyone pretends this was the plan.

The new tariff structure was submitted to the Federal Council in April 2026 for approval. The Federal Office of Public Health says the ongoing review will not be stopped by the creation of Prophysio. For patients and practices alike, that means the argument is far from over. The sector has now split its voice just as it prepares to bargain over the value of a minute. In a country proud of its pragmatism, that is a rather expensive way of discovering that consensus is easier to celebrate than to maintain.

Written by Andreas Hofer andreas.hofer@alpineweekly.com