Experts’ perspectives on SwissDRG: Second class care for vulnerable patient groups?

Abstract

On the 1st of January 2012, Switzerland introduced the diagnosis-related group hospital tariff structure (SwissDRG). It was recognised that healthcare provided to the most vulnerable patient groups would be a challenge for the new SwissDRG. Coincident with the implementation of SwissDRG, we explored hospital experts' perceptions of which patient groups are vulnerable under the SwissDRG system, what has changed for this group, as well as solutions to ensure adequate access to health care for them. We interviewed 43 experts from 40 Swiss hospitals. Participating experts named several vulnerable patient groups who share some common characteristics. These hospital experts were concerned about the patient groups that are not financially profitable and questioned the practicability of the current regulation. At the same time, they highlighted the complexity associated with caring for this group under the new SwissDRG and reported measures at the macro, meso, and micro levels to protect vulnerable patient groups from negative effects. To curb negative outcomes for vulnerable patient groups after the introduction of the SwissDRG, the Swiss legislation has introduced various instruments including the acute and transitional care (ATC) measures. We conclude that ATC measures do not produce the expected effect the legislators had hoped for. More health data is needed to identify situations where vulnerable patient groups are more susceptible to inadequate health care access in Switzerland.

Acute and Transitional Care or Rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland

“…The period of five months was chosen for resource reasons. The age limit was selected because older patients are likely to have a deficit in self-care, limited social resources and often need support post discharge [10,13]. We collected data for 660 cases during the study period.…”

“…The DRG payment system is generally expected to result in a reduction of length of stay (LOS) [6][7][8], raising concern that patients who need longer hospital stays or are in need of complex care might be discharged too early [9]. This vulnerable group is mostly presumed to be represented by elderly patients, children, patients with complex symptoms and patients without social network [10]. To circumvent the possible negative consequences of DRG, a new discharge option, Acute and Transitional Care (ATC) [11] was anchored into the Federal act on health insurance on 1st January 2011 as part of the nursing care financing system.…”

Acute and transitional care or rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland

“…The DRG payment system is generally expected to result in a reduction of length of stay (LOS) [ 6 – 8 ], raising concern that patients who need longer hospital stays or are in need of complex care might be discharged too early [ 9 ]. This vulnerable group is mostly presumed to be represented by elderly patients, children, patients with complex symptoms and patients without social network [ 10 ]. To circumvent the possible negative consequences of SwissDRG, readmissions within up to 18 days lead to no additional reimbursement for the hospital [ 11 ].…”

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

“…The DRG system might create false incentives because, in order to be economically efficient, hospitals could shorten the length of stay and the number of services provided, and at the same time, maximize the number of cases [ 5 ]. Moreover, hospitals could be encouraged to avoid high-cost patients by shifting them to other providers ("cost-shifting") or to discharge them inappropriately early ("bloody exits") [ 6 ].…”

“…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 ].…”