Inpatient tariffs in Switzerland
The three inpatient tariff systems SwissDRG, TARPSY and ST Reha regulate the reimbursement of inpatient cases in Switzerland. In contrast to outpatient treatment, inpatient treatment involves spending at least one night in the treatment or care facility. Accordingly, the costs of inpatient treatment are often higher than those of outpatient treatment, since in addition to the medical costs, there are also costs for accommodation and meals. In addition, the cases are usually medically more complex. Comparing the same treatments in outpatient and inpatient settings, patients in the inpatient setting often have more comorbidities, which also tends to result in higher costs. Thus, it is not surprising that inpatient treatments account for a relevant part of healthcare costs.
History of the development of inpatient tariffs in Switzerland
In 2007, the Federal Health Insurance Act (KVG, in German only) was revised in the area of hospital financing. Among other things, it was defined that inpatient tariffs and thus reimbursement for inpatient services should be regulated uniformly throughout Switzerland. Previously, different tariff systems were used depending on the canton. This prevented transparency and nationwide comparisons. As part of the revision, it was also stipulated that reimbursement must be based on performance-related flat rates (Art. 49 Para. 1 KVG).
Foundation of the tariff organization SwissDRG AG
Art. 49 (2) of the KVG stipulates that the tariff partners (payers, including health insurers) and service providers (hospitals and physicians) and the cantons must create an organization that draws up the tariff structure and is responsible for its further development. For this purpose, SwissDRG AG c was founded in Bern on January 18, 2008. The non-profit public limited company was founded jointly by all tariff partners and cantons in order to ensure the neutrality of the organization. Accordingly, the shareholders or supporting organizations of SwissDRG AG are made up of the following institutions:
- GDK (Conference of the Cantonal Health Directors)
- H+ (The Hospitals of Switzerland)
- santésuisse (The Swiss Health Insurers)
- Association of Swiss Physicians (FMH)
Since January 1, 2023, the sponsorship has also been expanded to include curafutura (The Innovative Health Insurers) and MTK (Medizinaltarifkommission UVG).
Structure of the inpatient per-case flat rate systems
All inpatient tariffs consist of two parts: The national tariff structure and the individual tariff agreements.
National tariff structures
The national tariff structures assign each inpatient case to a so-called case group on the basis of certain criteria such as main diagnosis, secondary diagnoses, procedures and other factors, such as age.
A case group represents a group of treatment cases that are as homogeneous as possible with regard to medical (diagnosis, treatment, etc.) and economic criteria. The definition of a case group and the level of its cost weight are the same throughout Switzerland and together form the rate structure of the reimbursement system. A cost weight is assigned to each case group and reflects the relative, compared to the other case groups, average treatment expenditure. SwissDRG AG uses the case cost data of Swiss hospitals, psychiatric and rehabilitation clinics as the basis for calculating the individual cost weights.
The structure of the grouping logic is regularly revised. This process occurs partly automatically through regular revisions by SwissDRG AG, but can also be actively initiated by organizations of the tariff partners through the so-called application procedure. If, for example, a tariff partner is of the opinion that a certain diagnosis or procedure is not correctly represented in a group, a corresponding modification of the tariff structure can be requested via an application. The modification is then simulated on the basis of data (with the real service and cost data of the Swiss hospitals), checked and, if necessary, implemented. As a result of such modifications, certain cases receive a lower or higher cost weighting.
Individual collective agreements - amount of baserates
The individual rate agreements specify the amount of the individual base rate and are negotiated by the rate partners. The base price, also known as the base rate, can vary in amount between the individual institutions. It is negotiated by the tariff partners, i.e. insurers and service providers (hospitals, psychiatric clinics, rehabilitation clinics), and approved by the responsible cantonal government. The basis of the negotiations is the so-called benchmarking, which is based on a national comparison of the case standard costs of hospitals, psychiatric clinics and rehabilitation clinics to an efficient institution. If the tariff partners do not agree on the base price, the canton sets it.
The three inpatient tariffs in Switzerland
The Federal Health Insurance Act (KVG) thus stipulates that inpatient services must be reimbursed with flat rates. SwissDRG AG has developed three national tariff structures for this purpose: SwissDRG for the acute somatic sector, TARPSY for inpatient psychiatry and ST Reha for inpatient rehabilitation.
Below is a brief overview of the three inpatient tariffs in the Swiss healthcare system:
SwissDRG (Swiss Diagnosis Related Groups) is the tariff system used for billing all inpatient acute-somatic hospital services. It has been in force since January 1, 2012. With the help of the SwissDRG flat rate system, inpatient hospital stays are billed uniformly throughout Switzerland. Learn more about this rate system on the corresponding knowledge page:
Since January 1, 2018, inpatient psychiatry cases have been reimbursed using the TARPSY (only in German) rate structure. This covers all inpatient service areas of adult, child and adolescent psychiatry. You can find out more about TARPSY on the following knowledge page:
Inpatient rehabilitation services will be reimbursed through the ST Reha (only in German) rate structure beginning January 01, 2022. Learn more about the latest inpatient tariff system on the following page:
For questions or projects concerning inpatient tariff systems, eonum can support you optimally with our great know-how. Learn more about our consulting services for inpatient tariffs in Switzerland: