Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients

Kutz, Alexander; Gut, Lara; Ebrahimi, Fahim; Wagner, Ulrich; Schuetz, Philipp; Müeller, Beat

doi:10.1001/jamanetworkopen.2018.8332

Cited by 47 publications

(36 citation statements)

References 33 publications

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“…[ 43 ] for the United States). Previous research for Switzerland provided evidence that the system change led to an increase in hospital readmissions [ 44 ]. Readmissions within 18 days of treatment are, however, already included in our records and do not constitute an additional stay, i.e.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition

Stucki

2021

Eur J Health Econ

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There is currently little systematic knowledge about the contribution of different factors to the increase in health care spending in high-income countries such as Switzerland. The aim of this paper is to decompose inpatient care costs in the Swiss canton of Zurich by 100 diseases and 42 age/sex groups and to assess the contribution of six factors to the change in aggregate costs between 2013 and 2017. These six factors are population size, age and sex structure, inpatient treated prevalence, utilization in terms of stays per patient, length of stay per case, and costs per treatment day. Using detailed inpatient cost data at the case level, we find that the most important contributor to the change in disease-specific costs was a rise in costs per treatment day. For most conditions, this effect was partly offset by a reduction in the average length of stay. Changes in population size accounted for one third of the total increase, but population structure had only a small positive association with costs. The most expensive cases accounted for the largest part of the increase in costs, but the magnitude of this effect differed across diseases. A better understanding of the factors related to cost changes at the disease level over time is essential for the design of targeted health policies aiming at an affordable health care system.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition

Stucki

2021

Eur J Health Econ

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“…The implementation of a DRG-based payment system is a well-established way to create transparency of costs and to help to reduce health-related expenditures [ 21 , 22 ]. Most research has focused on (inpatient) care in hospitals rather than outpatient care [ 11 ]. Accordingly, there is little data on primary care, especially about the outpatient care sector, which affect the consultations [ 4 , 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Korea, a decrease in length of hospital-stay and, on the other hand, an increase in outpatient visits were found as an effect of DRG introduction [ 8 , 9 ]. In Switzerland, there was no evidence of a significant deterioration in patient care or a significant change in the length of stay (LOS) under SwissDRG [ 6 , 10 , 11 ] though an association with readmission rates was found [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

et al. 2020

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Introduction In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investigate the effect of the implementation of DRG on costs and volumes in the primary care sector, on a nationwide basis in Switzerland. Methods The study retrospectively analysed yearly data, from 2008 to 2014, of almost 60 Swiss health insurers that covered almost all Swiss general practitioners, with a total number of patients which represented approximately 76% of the Swiss population. GP consultations, total numbers and rates, and the relative costs reimbursed (TARMED tariff values) in the Swiss federal states, cantons, which already introduced a DRG-like system before 2012 (AP-DRG), were compared to the GP consultations and costs reimbursed in the other cantons (DRG-naive). Regression discontinuity design analysis and mixed regression models, at cantonal level, were performed to evaluate the effect of the nationwide implementation of the Swiss DRG on health care demand and costs in the primary care setting. Change in outcome level and yearly trend pattern difference between groups (AP-DRG vs. DRG-naive) were examined. Results Overall, the total number of GP consultations and the relative TARMED values increased from 2008 to 2014. In the DRG naive, 15 cantons: in 2008, the number of GP consultations were 13,114,126, with a TARMED value of 1,194,957,157 CHF, and in 2014, the GP consultation were 13,752,511, with a TARMED value of 1,513,861,260 CHF. In the AP-DRG group, 11 cantons, the total number of GP consultations increased from 8,787,646, in 2008, to 9,347,168 in 2014 and the TARMED value increased from 896,673,657 CHF in 2008, to 1,100,203,508 CHF in 2014. The yearly trend pattern of GP consultations and TARMED values, in the AP-DRG group, were not significantly different from the respective trends in the DRG- naive and, overall, no significant change was detected in consultations and costs trends before and after 2012. Discussion/Conclusion This study found no evidence of any effect of the introduction of the SwissDRG on the yearly trend of primary care consultations and costs. Nevertheless, potential negative impacts on vulnerable patients, as chronically ill patients, could not be excluded and further investigation is required.

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“…As our results suggest that patients released to ATC are already frail, it is questionable whether the original aim to send these patients home is sustainable. Indeed, readmission rates increased since the introduction of SwissDRG and ATC [27], and studies from other settings show that frail patients are likely to be readmitted to acute care hospitals [28]. The effectiveness of ATC should, therefore, be reconsidered.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with post-acute discharge location after hospital stay: a cross-sectional study from a Swiss hospital

Zimmermann

Koné

Rost

et al. 2019

BMC Health Serv Res

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Background In 2012, Switzerland introduced the diagnosis-related group hospital payment system. Fearing that vulnerable patients may be discharged early, Acute and Transitional Care (ATC) was introduced to address the nursing care of patients who no longer needed an acute hospital stay. ATC is more costly for patients when compared to other discharge options like rehabilitation while providing less rehabilitative services. This study investigates factors associated with the place of discharge for patients in need of care. Methods Data was collected from 660 medical records of inpatients 50 years and older of the municipal hospital Triemli in Zurich, Switzerland. We used stepwise logistic regression to identify factors associated with their discharge into ATC or rehabilitation. Results Older patients with higher Delirium Observation Scale (DOS), lack of supplementary health insurance, resuscitation order and a lower social network were more likely to be discharged into ATC than rehabilitation. Conclusions The association of supplementary health insurance and social network with discharge into ATC or rehabilitation is problematic because patients that are already vulnerable from a financial and social perspective are potentially discharged into a more costly and less rehabilitative post-acute care facility. Electronic supplementary material The online version of this article (10.1186/s12913-019-4101-6) contains supplementary material, which is available to authorized users.

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Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients

Cited by 47 publications

References 33 publications

Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition

Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

Factors associated with post-acute discharge location after hospital stay: a cross-sectional study from a Swiss hospital

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