SwissDRG

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Swiss Diagnosis Related Groups , or SwissDRG system for short, in German: diagnosis-related groups or, better, diagnosis-related case groups , is a uniform flat-rate system in the healthcare sector that is linked to diagnoses . In Switzerland, the flat rate system SwissDRG and the associated new hospital financing was introduced on January 1, 2012.

The system is based on the German DRG ( G-DRG ) system and has been adapted to the particularities of the federally structured health system in Switzerland. SwissDRG AG is responsible for the development and further development as well as the adaptation and maintenance of the Swiss case flat rate system. It implements the legislative mandate that Parliament passed in December 2007. The non-profit public limited company was founded on January 18, 2008 and is a joint institution of service providers, insurers and the cantons . The broad support meets the different requirements and needs of the new compensation system. SwissDRG AG and its partner organizations are working together to ensure that the introduction of the flat-rate system in Switzerland is implemented successfully and to the benefit of everyone involved.

Basics

In the DRG system, patients are classified into case groups for billing purposes on the basis of medical (diagnoses, treatments performed) and demographic data (age, gender and the intake weight of children younger than 1 year). However, the case groups are not used to determine the medical treatment, but the differentiation is based on the typical effort (treatment costs) determined in the previous period . This case groups with a so-called review relation (Engl. (BR) cost weight (cw)) evaluated in the different treatment costs of the case group are reflected.

history

In December 2005, the responsible body in Switzerland decided to introduce a DRG system based on the German model. The SwissDRG emerged from the process of Helvetization (adaptation to the reality of Swiss treatment).

SwissDRG AG was founded on January 18, 2008 in Bern. The cantons and the health insurance tariff partners founded this not-for-profit stock corporation in order to standardize the tariff structure in the hospitals in the future and thus make it clearer and more transparent for patients. In this way, those postulates can be implemented that were anchored in the revised Health Insurance Act. The Chairman of the Board of Directors of SwissDRG AG is held by the Basel government councilor Carlo Conti.

The shareholders of SwissDRG AG are:

  • Swiss Conference of Cantonal Health Directors (GDK)
  • H + The hospitals in Switzerland
  • santésuisse The Swiss health insurers
  • UVG Medical Tariff Commission, MV / IV (MTK)
  • Association of Swiss Doctors (FMH)

aims

SwissDRG flat rates (Swiss Diagnosis Related Groups SwissDRG) are one of the instruments in the new hospital financing, which is intended to lead to more transparency in treatments and more performance-based remuneration for hospitals and clinics. It is no longer the hospitals themselves as institutions that are financed, but their services to patients. And these services should also be qualitatively comparable. In the future, patients will know which hospital offers which operation at what price and in what number. With the flat rate per case, insured persons, cantons and insurers receive transparent comparisons of the amount and prices of services from different hospitals. The financiers, cantons and health insurers are likely to be interested in the cheaper services. Private and public hospitals should be given the same length.

The new hospital financing brings new cantonal hospital lists, which should primarily be based on the criteria of quality and efficiency. With the new hospital financing, the cantons are obliged to pay all public and private hospitals on the hospital list their cantonal share of the medical treatment of patients. That is not the case today.

The new hospital financing also defines a new cost splitter between the cantons and health insurers. The cantons are now to pay at least 55% of the costs, and health insurances at most 45% of the costs. In the new hospital financing, the prices of the hospitals must financially cover the vocational training and further education of the non-university professions. So far, the cantons have financed these considerable costs from taxpayers' money. Investments are included in Swiss case flat rates from 2012. The prices for operations, therapies and inpatient care in hospitals and clinics include the costs for operating tables, equipment, medication and real estate. This is not the case under the earlier regime of departmental or daily flat rates. Before that, the cantons paid for investments in public and publicly subsidized hospitals and clinics with their tax money.

rating

The Association of Hospitals in Switzerland, H +, drew a good balance a year and a half after its introduction. The hospitals and clinics would have costs under control. According to association director Bernhard Wegmüller, the costs of compulsory inpatient health insurance grew moderately by 1.3 percent in 2012.

Upcoding

In Switzerland, all hospitals are obliged to observe the guidelines for uniform coding of the Federal Statistical Office. Correct use is controlled by health insurance companies.

Coding

Groupers are certified by SwissDRG AG. The coding manual of the Federal Statistical Office must be observed for the coding.

See also

literature

  • Wolfram Fischer: Diagnosis Related Groups (DRGs) and care. Basics, coding systems, integration options. Huber, Bern 2002, ISBN 3-456-83576-0 .
  • Jens Flintrop: Effects of the DRG introduction - economic logic becomes the measure of all things. In: Deutsches Ärzteblatt. 46, 2006, p. 3085 ISSN  0012-1207 online edition
  • Peter Indra: The introduction of the SwissDRGs in Swiss hospitals and their effects on the Swiss healthcare system. Publishing house Switzerland. Society for Health Policy SGGP, Zurich 2004, ISBN 3-85707-803-0 .
  • Ludwig Kuntz, Stefan Scholtes, Antonio Vera: DRG Cost Weight Volatility and Hospital Performance. In: OR Spectrum. Vol. 30 (2008), No. 2, pp. 331-354.
  • Thomas Müller: DRG basic knowledge for doctors and coders. Medizificon Verlag , 2007, ISBN 978-3-9810027-5-1 .
  • Boris Rapp: practical knowledge DRG - optimization of structures and processes. Kohlhammer-Verlag, 2007, ISBN 978-3-17-019396-3 .

Individual evidence

  1. ↑ SwissDRG. In: swissdrg.org. Retrieved May 19, 2019 .
  2. ↑ SwissDRG AG
  3. ↑ The hospitals draw positive first conclusions on Swiss DRG. In: NZZ. May 27, 2013. Retrieved August 27, 2013.
  4. ↑ Coding Guide. ( Memento of the original from November 14, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. of the Federal Statistical Office, accessed on August 27, 2013. @1@ 2Template: Webachiv / IABot / www.bfs.admin.ch
  5. ↑ Archived copy ( Memento of the original from October 18, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , FAQ page of the SwissDRG @1@ 2Template: Webachiv / IABot / webapps.swissdrg.org

Web links