Since 1 January 2012, inpatient care provided by acute hospitals and birth centres has been paid for on the basis of diagnosis related grouping.
Amendments to the Swiss Federal Health Insurance Act (KVG/LAMal) related to hospital funding that entered into force on 1 January 2009 created a legal framework for standardised payments for inpatient care provided by hospitals and birth centres on the basis of diagnosis related grouping (DRG).
Under the DRG system, each hospital case is allocated to so-called diagnosis related groups (for example appendectomies) on the basis of specific criteria, including the primary and secondary diagnoses. The flat amount paid for each DRG is calculated by multiplying a base rate by a cost weight.
The DRGs and cost weights are defined on a standardised basis across Switzerland, and together constitute the tariff structure for the funding system. Formulating the nationwide tariff structure and reviewing it on an annual basis is one of the main tasks of SwissDRG AG, an organisation run jointly by care providers, insurers and the cantons. The tariff structure has to be submitted to the Federal Council for approval.
Since 1 January 2012, acute inpatient care has been funded according to a uniform nationwide system (the SwissDRG or Swiss Diagnosis Related Groups sys-tem) of percase flat fees paid on the basis of diagnosis related grouping (DRG).
Diagnosis related groups
In a DRG (diagnosis related group) system, hospital cases (for example treatment to correct cleft lip and cleft palate) are brought together on the basis of medical and economic criteria to create groups (DRGs) that are as homogeneous as possible. Each hospital case is allotted to a specific DRG on the basis of medical (diagnosis, treatment, etc.) and other criteria (patient’s age, etc.). These DRGs are the same all over Switzerland.
The cost weight for a specific DRG reflects the average cost of treatment relative to the other DRGs covered by the tariff structure. Cost weights are calculated using case data from selected hospitals.
The base rate is a type of average amount for inpatient treatments at a specific hospital. Base rates, which can vary depending on the facility.
Base rates are agreed by the tariff partners (insurers and care providers) and approved by the canton responsible. If the tariff partners are unable to agree a base rate it is set by the canton.
Other remuneration systems with service-related flat rates
Standardised tariff structures for the remuneration of inpatient services in Switzerland must also apply to the other two areas with inpatient hospital treatment: In the area of psychiatry, the TARPSY tariff structure was introduced on 1 January 2018, while in the area of rehabilitation, the ST Reha tariff structure is currently being developed by SwissDRG AG. In the future, inpatient hospital services will thus be remunerated in all three inpatient areas (acute care, rehabilitation and psychiatry) based on tariff structures that are standardised throughout Switzerland.
Additionally, the remuneration of specific services relating to the transplantation of solid organs and haematopoietic stem cells, which cannot be or have not yet been regulated through the standardised SwissDRG tariff system, is the object of two tariff agreements between the Swiss association for joint responsibilities of health insurers (SVK) and H+ The Hospitals of Switzerland (H+).
Evaluation of Health Insurance Act (HIA) revision on hospital financing
The impact of the HIA revision on hospital financing was studied as part of an evaluation. All of the reports connected with the evaluation can be found on the evaluation website.
Last modification 22.04.2020