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