Elsevier

Health Policy

Volume 122, Issue 6, June 2018, Pages 577-582
Health Policy

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

https://doi.org/10.1016/j.healthpol.2018.03.001Get rights and content

Highlights

  • Swiss hospital experts are aware of particularly vulnerable patient groups.

  • Vulnerable patient groups are insufficiently represented in the new SwissDRG tariff structure.

  • Swiss hospitals are confronted with the challenges that vulnerable patients pose.

  • Experts report macro, meso, and micro level measures to protect vulnerable patients.

  • Legislative measures to protect vulnerable patients do not show the desired effect.

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.

Section snippets

Background

With the introduction of the Swiss diagnosis-related group (DRG) hospital in-patient payment system as of January 2012, the Swiss Federal Council aimed to create an incentive to contain the increasing cost of healthcare [1]. This new tariff structure forces hospitals to produce economically efficient outcomes by reducing the length of stay and the number of services provided as well as maximizing the number of (profitable) cases [[2], [3], [4]]. Scholars and healthcare professionals have feared

Methods

Participant recruitment for this study began in February 2012 and the last interview took place in December 2012. We purposively recruited a sample of 43 experts working in 40 hospitals in Switzerland. The first author contacted all prospective study participants via letter informing them about the study and requesting their participation. All of the 43 experts contacted, agreed to participate in this study. The 40 hospitals were classified as follows: 7 university hospitals (including children

Results

Our analysis of the topic, vulnerable patient groups, and the SwissDRG resulted in three themes: (a) description and awareness of vulnerable patient groups; (b) changes after the implementation of the new tariff structure; and (c) measures to ensure an adequate access to health care.

Discussions

Swiss hospital experts were aware of particularly vulnerable patient groups and were confronted with the challenges that this group poses as a result of the implementation of the SwissDRG in 2012. Similar to what is described in the literature [12], patients are deemed vulnerable because of their (a) health status; (b) age; and (c) socio-economic background (e.g. immigrants, refugees, homeless, and prisoners). Although we could not state that discrimination against such groups is taking place,

Conclusion

The study reveals that the changing economic incentives in inpatient care may induce a shift in the service supply of hospitals. Especially services for patients with a high need for care are less attractive for hospitals. Our research also highlights important gaps that persist with the introduction of DRGs in Switzerland. First, data are lacking about inpatient-outpatient transitions. It is of crucial importance to determine what the consequences are if inpatient care is now often terminated

Funding

This study was funded by Swiss National Science Foundation (Project Number CRSII3_132786).

Conflict of interest

The authors state that there is no conflict of interest.

Acknowledgements

The authors thank the 43 participants for their time and for sharing their opinions. The first author received personal grant from the Research Fund of the University of Basel for excellent researchers.

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