DRG

Inpatient care provided in hospitals underwent a major change in 2012. Since then, hospitals have no longer been funded through per diem flat rates but through the services they provide for patients. Prior to 2012, the same services were paid for differently depending on the canton. Today, they are paid for on the basis of uniform national tariffs known as diagnosis-related groups (DRG). SwissDRG AG, a non-profit company combining service providers, insurers and the cantons, is responsible for introducing, refining and updating inpatient tariff structures. SwissDRG classifies services into case groups on the basis of the main and subsidiary diagnoses, severity and other criteria as well as the treatments provided. This results in a flat rate for each case group that is reimbursed by the health insurer.

The purpose of this system is to create greater transparency, promote economic efficiency and correct existing misplaced incentives. Resources are used appropriately for needs and more efficiently because hospitals are paid only for the services they provide. But there is a natural limit to funding by means of per case flat rates.

Flanking measures necessary

It is not possible to represent medical treatments perfectly in all areas even in an optimally differentiated system. Systematic funding shortfalls arise with medical innovations and therapies because it takes around five years for a new medicinal product or a new treatment method to be included in and paid for through the per case flat rate system. Also, therapies for small groups of patients that can be provided at only a small number of specialised hospitals distort the case groups and lead to underfunding in specialised centres and overfunding in other hospitals. Additional payments are therefore needed for new examination and treatment methods to ensure comprehensive and rapid access to therapies. Without this kind of flanking measure, such as additional payments, access to new therapies would be delayed and regionally variable.