According to the Federal Health Insurance Act (KVG/LAMal), inpatient services must be reimbursed with flat rate tariffs. To that end, the organization SwissDRG AG has developed three nationally uniform tariff structures throughout Switzerland.
As part of the revision of the KVG/LAMal in the area of hospital financing, which came into effect on January 1, 2009, the legal foundations were laid to newly structure the reimbursement system of inpatient services of hospitals and birth centres. In the new system, reimbursements are based on nationally uniform service-related flat rate tariffs.
In this system, each hospitalization is allocated to a group of treatment cases - so-called case groups (e.g. appendectomy, personality and behavioral disorders, pulmonary rehabilitation) – depending on certain criteria such as main diagnosis, secondary diagnoses and other factors.
The definition of the case groups and the value of the cost weights are uniform throughout Switzerland and together form the tariff structure of the reimbursement system. The creation and annual development of the nationwide tariff structures is one of the central tasks of the SwissDRG AG, a joint organization of service providers, insurers and cantons. The tariff partners must submit the tariff structure to the Federal Council for approval.
Three national tariff structures have been developed for the reimbursement of inpatient treatments (see below). In addition, the reimbursement of specific services in connection with the transplantation of solid organs as well as hematopoietic stem cells, which cannot be or have not yet been included in the uniform tariff structure SwissDRG, are regulated through two tariff agreements between the Swiss association for joint tasks of health insurers (SVK) and H+ Die Spitäler der Schweiz (H+).
SwissDRG: tariff structure for acute care
Since January 1, 2012, the SwissDRG (Swiss Diagnosis Related Groups) tariff structure has been used throughout Switzerland for the reimbursement of inpatient acute-somatic hospital services. It is applied in hospitals and birth centres. The reimbursement (service-related flat rate tariff) per "case group" results from multiplying the corresponding "cost weight" with a "baserate".
TARPSY: tariff structure for psychiatry
The TARPSY tariff structure has been used for the reimbursement of inpatient services in psychiatry since January 1, 2018. It defines relative daily costs, which have the characteristic that they are degressive over time: the longer the length of stay, the lower the relative daily costs. Thus, to determine the reimbursement for an inpatient psychiatric treatment, the "cost weight" must be multiplied by the length of stay and the "baserate".
ST Reha: tariff structure for rehabilitation
Since January 1, 2022, inpatient rehabilitation treatment is reimbursed via the ST Reha tariff structure. Similar to TARPSY, it defines relative cost weights per day. The reimbursement of an inpatient rehabilitation treatment is calculated by multiplying the "cost weight" by the length of stay and the "baserate".
Case group
In a DRG system (Diagnosis Related Groups), inpatient treatments are summarized into groups (e.g. correction of a cleft lip and palate in infants; manic disorders in patients over 17 years of age, rehabilitation in internal medicine or oncology with special functional limitations) which are as homogeneous as possible with regard to medical and economic criteria. Each hospitalization is assigned to a defined case group (DRG) on the basis of medical (diagnosis, treatment, etc.) and other criteria (age of the patient, etc.). These case groups are identical throughout Switzerland.
Cost weight
The cost weight of a case group reflects the relative - i.e., compared to the other case groups represented in the tariff structure - average cost of a treatment. The cost weights are calculated based on case cost data from selected hospitals.
Baserate
The baserate is a sort of average value for an inpatient treatment in a particular hospital. The baserate may vary depending on the hospital.
The tariff partners (insurers and service providers) negotiate the baserate and the responsible canton needs to approve the agreed upon baserate. If the tariff partners cannot find an agreement, the canton sets the baserate.
Evaluation of the KVG/LAMal revision of hospital financing
The effects of the KVG/LAMal revision in the area of hospital financing were examined as part of an evaluation. All reports of the evaluation can be found on the evaluation website.
Last modification 02.12.2021
Contact
Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Tariffs and Principles Division
Schwarzenburgstrasse 157
3003
Bern
Switzerland
Tel.
+41 58 462 37 23