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

Area of Science:

• Health Services Research
• Hospital Management
• Healthcare Policy

Background:

• Switzerland implemented the diagnosis-related group hospital tariff structure (SwissDRG) in 2012.
• Vulnerable patient groups were identified as a potential challenge for the new SwissDRG system.
• Ensuring equitable healthcare access for all patient populations is a key healthcare policy objective.

Purpose of the Study:

• To explore Swiss hospital experts' perceptions of vulnerable patient groups under SwissDRG.
• To understand changes in care for these groups post-SwissDRG implementation.
• To identify expert-proposed solutions for safeguarding vulnerable patients' healthcare access.

Main Methods:

• Qualitative study involving interviews with 43 healthcare experts from 40 Swiss hospitals.
• Exploration of expert opinions on patient vulnerability, system challenges, and mitigation strategies.
• Analysis of macro, meso, and micro-level measures for protecting vulnerable patient groups.

Main Results:

• Experts identified vulnerable groups as those less financially profitable under SwissDRG, citing concerns about system practicability and care complexity.
• Reported macro, meso, and micro-level measures aim to mitigate negative impacts on vulnerable patients.
• Introduced acute and transitional care (ATC) measures did not fully achieve their intended effect.

Conclusions:

• The SwissDRG system presents challenges for financially less profitable patient groups.
• Current mitigation strategies, including ATC measures, may be insufficient to guarantee adequate healthcare access for vulnerable populations.
• Further health data analysis is crucial to pinpoint specific risks and improve access for vulnerable patients in Switzerland.