Switzerland to adopt DRGs system
The Swiss hospital system is facing a radical change. Billing by Diagnosis Related Groups (DRGs) is about to be introduced. European Hospital's correspondent in Switzerland, Dr André Weissen,* approached Dr Carlo Conti, President of SwissDRG AG to discuss some of the controversial issues involved in the switch to DRGs
Switzerland’s hospital system is highly complicated because the 26 cantons each have different regulations. Nonetheless, they all have one common feature, i.e. billing is calculated on a per diem basis, which means that medical insurers simply pay an agreed amount per day spent in hospital – independent of a patient’s diagnosis. Any further costs are covered by the hospital, meaning the state or private hospital operators pay.
Dr Carlo Conti, President of SwissDRG AG, based in Basle, will organise the switch to DRGs. ‘There can be no doubt that the current billing systems in Switzerland contain some misguided incentives and are therefore causing a conflict when it comes to achieving more efficiency for hospitals. The partners in the healthcare sector and the world of politics agree that a system change to DRGs would result in real improvements. National, standardised tariffs would also make it easier to achieve comparability and to promote the exchange of healthcare services between different geographical areas within Switzerland,’ he told European Hospital.
What do they hope to achieve? ‘The introduction of DRG case-based lump sums is to achieve two things: More transparency of all medical services offered and provided in a hospital and ideally a performance-based kind of remuneration. In our Federal structure, the DRGs will provide a prerequisite for more competition between the service providers because services and products delivered by hospitals can be compared, regarding cost as well as quality.’
Switzerland is to adopt the German case-based system, for example, although this has now fallen into disrepute. Why is it in the plan? ‘We looked at all available options and came to the conclusion that the German system best meets our needs technically. The problems in German hospitals arise for different reasons,’ he explained. ‘The negative effects are less to do with the billing system, they are more to do with the type of overall hospital financing and budgeting.’
German university hospitals are considered the big losers in terms of DRGs. How are all the Swiss hospitals – large, small, public and private – to be treated in the same way? ‘In Germany, other than in Switzerland, no investment allowances are included in the case-based sums. This led to an investment backlog in public hospitals,’ Dr Conti pointed out. ‘The new system means that all hospitals included on a Canton hospital list are put on a par. This does away with the difference between public and private hospitals. For the public hospitals it means the discontinuation of the governmental deficit guarantee and equated, performance-based financing for all hospitals. The rules of the game will be the same for everyone, i.e. a significant improvement to the status quo.’
Apart from the treatment costs, hospitals also have to undertake investments to keep up to date and remain competitive. Is the introduction of DRGs not actually counterproductive in this case? ‘I think the connection you outline here is less rigid,’ Dr Conti responded. ‘The right investments will need to continue in the future, enabling us to provide our services. However, as I said before, other than in Germany, the investment costs are treated as chargeable costs and paid through the DRG case-based lump sum. This increasingly links the investment to the actual amount of services provided. We hope to guard against a financing gap for investments in this way.’
* In 2007, the Swiss Parliament passed the new Hospital Financing Draft. This stipulates the introduction of a national, standardised tariff structure (SwissDRG). The SwissDRG is due to be introduced nationwide by 1 January 2012 at the latest.
01.07.2008
