Inpatient-outpatient transitions in the era of DRGs: the legal framework and current practice

Cost containment is a major concern for contemporary health care systems that aim to sustain affordable health care and at the same time assure its quality. Switzerland has followed other countries such as the United States and Germany to contain the cost of its health care by introducing a new reimbursement system for inpatient care using the Swiss Diagnosis-Related Group (SwissDRG).
A previous study analysed the legal framework governing SwissDRG and interviewed hospital managers to explore how hospitals reacted to the DRG-based reimbursement system (SNF-Sinergia “Assessing the Impact of Diagnosis Related Groups (DRG) on patient care and professional practice in Switzerland“). It was found that the changing economic incentives in inpatient care induce a shift in the services supply of hospitals. Especially services with a high proportion of nursing care are less attractive for hospital.
A comprehensive and patient-orientated view must also take into account another important change in the Swiss regulations. Since 2011 amendments have been made to reorganize the financing of care (“Acute and transitional care (ATC) measures” Federal Law of 13.06.2008). The interplay between the new hospital financing and financing of inpatient and outpatient care provided by nursing homes and home care organizations has to be evaluated.
The objectives of the project are:

(1) Advance knowledge on the extent in which the legal frameworks concerning the two reformed financing systems interact and whether the present regulations provide sufficiently clear guidance.

(2) Obtain new data on stakeholder views concerning the implementation of the new legal frameworks in five different cantons.

(3) Collect high quality quantitative data from the medical records to assess decision making at the intersection of inpatient and intermediate or outpatient care and to explore healthcare and other factors that influence such decisions, including the question how the two reformed financing systems interfere with the decisions of providers and insured persons.

(4) Collect qualitative data about patient views on the SwissDRG as well as the new ATC measures and how these have affected the quality of health care that they received.
In sum, the project will provide legal analysis and empirical data for decision-making in health care financing at the inpatient-outpatient transition. The interdisciplinary context allows a unique opportunity to disseminate solutions and recommendations including stakeholder views.

This project is funded by the Swiss National Science Foundation

Project start:


Project Applicants

Prof. Thomas Gächter (University of Zurich)
Prof. FH. Agnes Leu (Careum, Zurich)
Prof. Dr. med. Bernice Elger