SwissDRG tariff
The SwissDRG (Swiss Diagnosis Related Groups; in German only) inpatient tariff has been in practice in Switzerland since 1 January 2012. This tariff system, which is based on flat rates per case, regulates the billing of inpatient acute-somatic hospital services. According to the Federal Health Insurance Act (KVG), the reimbursement of inpatient hospital services is to be regulated uniformly throughout Switzerland.
SwissDRG AG (in German only) is responsible for the development and adaptation of the inpatient flat rate system.
The SwissDRG flat rate system provides that each hospital stay is assigned to a case group with its own cost weighting on the basis of certain criteria. The main diagnosis and secondary diagnoses from the ICD-10-GM diagnosis catalogue, the treatments and procedures performed from the CHOP catalogue as well as some demographic characteristics such as age and gender and other variables from the so-called medical statistics are relevant for grouping. Finally, the reimbursement for a hospital stay is calculated by multiplying the cost weight of a case group by the base price in CHF, which is defined in individual tariff agreements.
The SwissDRG tariff system thus consists of two parts: The national tariff structure and the individual tariff agreements. All three inpatient tariff systems in Switzerland are based on this concept, as it is also described on the knowledge page on all inpatient tariff systems.
Structure and functioning of the SwissDRG tariff
The SwissDRG tariff is divided into individual:
- MDCs (Major Diagnostic Categories)
- Basic DRGs
- DRGs (Diagnosis Related Groups)
The MDCs represent 26 individual chapters of the tariff system, which are defined by a specific group of principal diagnoses. In most cases, this also corresponds to certain medical specialities. For example, orthopaedics cases with an orthopaedic principal diagnosis are mainly grouped into MDC 08 “Diseases and disorders of the musculoskeletal system and connective tissue”.
Within the individual MDCs, cases are further subdivided into different base DRGs, which are usually defined by specific diagnoses and/or procedures. To remain in our example of orthopaedics: Cases with an implantation of a hip prosthesis, for example, are mainly assigned to the base DRG I46 “Implantation, replacement or revision of a hip endoprosthesis”.
The base DRGs, in turn, are further subdivided into individual DRGs according to resource consumption (or level of costs), whereby the DRG with the suffix A has the highest cost weight in each case. Thus, the basic DRG I46 in SwissDRG version 12.0 is further subdivided into the 3 DRGs I46A, I46B and I46C, each with different cost weights.
In addition to the reimbursement of the individual per-case flat rates, certain very expensive services (such as medicines or implants) are reimbursed separately by means of so-called additional charges. In addition to the structure of the decision tree logic and the amount of the individual cost weights, these are also redefined and calculated every year.
Through the SwissDRG application procedure, all tariff partners can influence the further development of the SwissDRG tariff and initiate the review of certain adjustments. eonum offers various services related to the SwissDRG application procedure. You can find out more about them on the following offers page:
The cost weight of a case group is recalculated each year on the basis of the actual costs incurred by Swiss hospitals and published in the catalogue of flat rates per case. The SwissDRG tariff structure is adapted each time with regard to both the grouping logic and the cost weights. The new version is submitted to the Federal Office of Public Health (FOPH) and the Federal Council. Afterwards, the new version and thus also all adjustments must be approved by the Federal Council. The currently valid catalogue of flat rates per case (SwissDRG 13.0 2024) can be found here (in German only).
The assignment of a case to a specific DRG (case group) is done via grouping software, also called a grouper. The so-called definition manual provides information on the exact definition or conditions of the individual case groups and thus explains the rules on which the assignment of the grouper is based. You can find the currently valid definition manual (SwissDRG 13.0 2024) as a PDF here (in German only). However, the structure of the tariff structure and the search for individual DRGs is easier to understand with the help of the online definition manual (in German only), which was developed by eonum on behalf of SwissDRG AG.
More on the topic
Learn more about the two main underlying catalogues, ICD and CHOP, which are used to code the diagnoses and procedures (treatments) of each case:
eonum offers various advisory services on inpatient tariffs in acute care and the SwissDRG tariff structure. You can find more information on the corresponding offers page: