IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0241179.html
   My bibliography  Save this article

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

Author

Listed:
  • Omar Al-Khalil
  • Fabio Valeri
  • Oliver Senn
  • Thomas Rosemann
  • Stefania Di Gangi

Abstract

Introduction: In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investigate the effect of the implementation of DRG on costs and volumes in the primary care sector, on a nationwide basis in Switzerland. Methods: The study retrospectively analysed yearly data, from 2008 to 2014, of almost 60 Swiss health insurers that covered almost all Swiss general practitioners, with a total number of patients which represented approximately 76% of the Swiss population. GP consultations, total numbers and rates, and the relative costs reimbursed (TARMED tariff values) in the Swiss federal states, cantons, which already introduced a DRG-like system before 2012 (AP-DRG), were compared to the GP consultations and costs reimbursed in the other cantons (DRG-naive). Regression discontinuity design analysis and mixed regression models, at cantonal level, were performed to evaluate the effect of the nationwide implementation of the Swiss DRG on health care demand and costs in the primary care setting. Change in outcome level and yearly trend pattern difference between groups (AP-DRG vs. DRG-naive) were examined. Results: Overall, the total number of GP consultations and the relative TARMED values increased from 2008 to 2014. In the DRG naive, 15 cantons: in 2008, the number of GP consultations were 13,114,126, with a TARMED value of 1,194,957,157 CHF, and in 2014, the GP consultation were 13,752,511, with a TARMED value of 1,513,861,260 CHF. In the AP-DRG group, 11 cantons, the total number of GP consultations increased from 8,787,646, in 2008, to 9,347,168 in 2014 and the TARMED value increased from 896,673,657 CHF in 2008, to 1,100,203,508 CHF in 2014. The yearly trend pattern of GP consultations and TARMED values, in the AP-DRG group, were not significantly different from the respective trends in the DRG- naive and, overall, no significant change was detected in consultations and costs trends before and after 2012. Discussion/Conclusion: This study found no evidence of any effect of the introduction of the SwissDRG on the yearly trend of primary care consultations and costs. Nevertheless, potential negative impacts on vulnerable patients, as chronically ill patients, could not be excluded and further investigation is required.

Suggested Citation

  • Omar Al-Khalil & Fabio Valeri & Oliver Senn & Thomas Rosemann & Stefania Di Gangi, 2020. "Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-14, October.
  • Handle: RePEc:plo:pone00:0241179
    DOI: 10.1371/journal.pone.0241179
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241179
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0241179&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0241179?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Yael Rachamin & Rahel Meier & Thomas Grischott & Thomas Rosemann & Stefan Markun, 2019. "General practitioners’ consultation counts and associated factors in Swiss primary care – A retrospective observational study," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-13, December.
    2. Or., Zeynep, 2014. "Implementation of DRG Payment in France: Issues and recent developments," Health Policy, Elsevier, vol. 117(2), pages 146-150.
    3. Leu, A. & Wepf, H. & Elger, B. & Wangmo, T., 2018. "Experts’ perspectives on SwissDRG: Second class care for vulnerable patient groups?," Health Policy, Elsevier, vol. 122(6), pages 577-582.
    4. Chanturidze, Tata & Esau, Mike & Hölzer, Simon & Richardson, Erica, 2016. "Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges," Health Policy, Elsevier, vol. 120(9), pages 987-991.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Buczak-Stec, Elżbieta & Goryński, Paweł & Nitsch-Osuch, Aneta & Kanecki, Krzysztof & Tyszko, Piotr, 2017. "The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012)," Health Policy, Elsevier, vol. 121(11), pages 1186-1193.
    2. Jian, Weiyan & Lu, Ming & Liu, Guofeng & Chan, Kit Yee & Poon, Adrienne N., 2019. "Beijing's diagnosis-related group payment reform pilot: Impact on quality of acute myocardial infarction care," Social Science & Medicine, Elsevier, vol. 243(C).
    3. Li Wu & Conghua Ji & Hanti Lu & Xuewen Hong & Shan Liu & Ying Zhang & Qiushuang Li & Sijia Huang & Penglei Zhou & Jiong Yao & Yuxiu Hu, 2018. "Standardization of medical service indicators: A useful technique for hospital administration," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-13, November.
    4. Rachet-Jacquet, Laurie & Toulemon, Léa & Rochaix, Lise, 2021. "Hospital payment schemes and high-priced drugs: Evidence from the French Add-on List," Health Policy, Elsevier, vol. 125(7), pages 923-929.
    5. Gautam Gowrisankaran & Keith A. Joiner & Jianjing Lin, 2016. "How do Hospitals Respond to Payment Incentives?," NBER Working Papers 22873, National Bureau of Economic Research, Inc.
    6. Chanturidze, Tata & Esau, Mike & Hölzer, Simon & Richardson, Erica, 2016. "Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges," Health Policy, Elsevier, vol. 120(9), pages 987-991.
    7. Meng, Zhaolin & Hui, Wen & Cai, Yuanyi & Liu, Jiazhou & Wu, Huazhang, 2020. "The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis," Health Policy, Elsevier, vol. 124(4), pages 359-367.
    8. Sutherland, Jason M. & Liu, Guiping & Crump, R. Trafford & Law, Michael, 2016. "Paying for volume: British Columbia’s experiment with funding hospitals based on activity," Health Policy, Elsevier, vol. 120(11), pages 1322-1328.
    9. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    10. Chien, Ling-Chen & Chou, Yiing-Jenq & Huang, Yu-Chin & Shen, Yi-Jung & Huang, Nicole, 2020. "Reducing low value services in surgical inpatients in Taiwan: Does diagnosis-related group payment work?," Health Policy, Elsevier, vol. 124(1), pages 89-96.
    11. Zuzana Kotherová & Martina Caithamlová & Juraj Nemec & Kateřina Dolejšová, 2021. "The Use of Diagnosis-Related Group-Based Reimbursement in the Czech Hospital Care System," IJERPH, MDPI, vol. 18(10), pages 1-18, May.
    12. Zeynep Or & Coralie Gandré & George Wharton, 2022. "Soutenabilité et résilience du système de santé français," Working Papers DT88, IRDES institut for research and information in health economics, revised Jun 2022.
    13. Bertezene, Sandra, 2018. "Control of hospitals and nursing homes in France: The 2016 reform may indirectly improve a dysfunctional system," Health Policy, Elsevier, vol. 122(4), pages 329-333.
    14. Spiess, Adrian Andrea Flavio & Skempes, Dimitrios & Bickenbach, Jerome & Stucki, Gerold, 2022. "Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point," Health Policy, Elsevier, vol. 126(3), pages 173-182.
    15. Manon Belhassen & Olivier Hanon & Philippe Gabriel Steg & Isabelle Mahé & Mélanie Née & Flore Jacoud & Faustine Dalon & François-Emery Cotté & Dominique Guitard-Dehoux & Claire Marant-Micallef & Eric , 2023. "Apixaban versus other anticoagulants in patients with nonvalvular fibrillation: a comparison of all-cause and event-related costs in real-life setting in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 867-875, August.
    16. Field, Robert I. & Keller, Catherine & Louazel, Michel, 2020. "Can governments push providers to collaborate? A comparison of hospital network reforms in France and the United States," Health Policy, Elsevier, vol. 124(10), pages 1100-1107.
    17. Anne Albert-Cromarias & Catherine dos Santos, 2020. "Les paradoxes dans un établissement de santé : reconstruire du sens par l’innovation managériale," Post-Print hal-03024010, HAL.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0241179. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.