Ethical research on the implementation of DRGs in Switzerland - a challenging project

Abstract

Diagnosis Related Groups (DRGs) are currently being introduced on a national scale as a prospective reimbursement scheme in Swiss in-patient hospital care, replacing any remaining retrospective day-rate arrangements. DRGs are expected to promote transparency and efficiency while helping to contain health care costs. The governmental decision to introduce DRGs has caused considerable controversy among different stakeholders, due to diverging appraisals of what will happen when DRGs are introduced as an economic management tool in Switzerland. The controversial discourse on DRGs is particularly interesting from an ethical point of view, since all arguments inevitably contain ethical considerations. In this paper we summarise the results of our exploratory ethical studies that have led to a larger research project funded by the Swiss National Science Foundation: "Impact of Diagnosis-Related Groups (DRGs) on patient care and professional practice" (IDoC). In section 1: 'Developing an understanding of the ethical issues at stake' we briefly explain how DRGs work, what the intended effects are, what the public is concerned about and what the scientific research tells us so far. In section 2: 'Developing an ethical framework for research on DRGs in Switzerland' we summarise the ethical issues and explain the ethical framework we will use in order to perform research on the complex issue of DRGs in Switzerland. Only once a profound understanding of the challenges exists can research on the ethical implications of DRGs be successful.

Baby‐Friendly Hospital designation has a sustained impact on continued breastfeeding

“…Even accounting for hospitals withdrawing from or losing the BFH certification, the overall number of BFHs increased up to 2005 (Forrester-Knauss, Merten, Weiss, Ackermann-Liebrich, & Stutz, 2013). Thereafter, BFHs decreased slightly and then markedly from 2012 onwards, when a hospital financing system based on Diagnosis Related Groups was introduced in Switzerland (Wild, Pfister, & Biller-Andorno, 2012). Budgetary pressures accompanied the new financing system, and a conflict arose between financial objectives and time spent monitoring Baby-Friendly (BF) practices and offering educational and emotional support to mothers (Conzelmann-Auer, 2009;Furrer, Schwab, & Oetterli, 2005).…”

Emerging Concepts and Designing Effectiveness Research in the Process of Care of Patients Hospitalized with an Uncomplicated Acute Coronary Syndrome

“…Previous studies reported a reduction of LOS at hospital after the implementation of DRG-based financing [5][6][7], but some controversies occurred regarding potential damaging effects on the quality of care of patients or on the professionals' autonomy and satisfaction. A recent publication provided a framework on some ethical concerns of DRG implementation defined at different levels and themes that were interdependant: (1) macro-level (viability of the health system, quality of the health care system, development of actors and political organizations), (2) meso-level (hospital organization, complex management) and 3micro-level (interaction between patient and care givers in the systemic context) [8].…”

Continuous versus routine EEG in critically ill adults: reimbursement analysis of a randomised trial

“…In addition to these logistics issues, in the USA cEEG is related to higher hospitalisation charges compared with rEEG [6,8,9]; that hospital reimbursement system nevertheless differs from those of other settings, since different professional fees are applied to EEG procedures. Several European countries including Switzerland [10,11], Australia, Canada and Japan [12] use diagnosis-related groups (DRGs), whose purpose is to classify patients according to demographics, principal and secondary diagnoses, comorbidities and complications; procedures performed play a relatively minor role. Based on this information, patients will belong to a certain DRG [13] associated with a specific reimbursement estimated on similar cases [11].…”