Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 1920 (2013)

Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: an observational study

  • Noemi Weissenberger
  • Désirée Thommen
  • Philipp Schuetz
  • Beat Mueller
  • Christoph Reemts
  • Thomas Holler
  • Juerg A Schifferli
  • Martin Gerber
  • Balthasar L Hug
Cite this as:
Swiss Med Wkly. 2013;143:w13790


BACKGROUND: Reimbursement for inpatients in Switzerland differed among states until 2012. Some hospitals used diagnosis related groups (DRG) and others used fee-for-service (FFS). We compared length of hospital stay (LOS), patient satisfaction and quality of life between the two systems before a nation-wide implementation of DRG.

METHODS: In a prospective, two-centre observational cohort study, we identified all patients with a main diagnosis of either community-acquired pneumonia, exacerbation of chronic pulmonary obstructive disease, acute heart failure or hip fracture from January to June 2011 and performed a systematic questionnaire survey 2–4 months after hospital discharge.

RESULTS: Of 1,093 inpatients, 450 were included. Mean age was 71.1 (±SD 19.5) years (48% male). Patients in the FFS hospital were older (mean age 74.8 vs. 65.2 years; p <0.001) and suffered from more co-morbidities. Mean LOS was 9 days and shorter in the all-patient DRG (AP-DRG) hospital (unadjusted mean 8.2 vs. 9.5 days, p = 0.04). After multivariate adjustment, no significant difference in LOS was found (p = 0.24). More patients from the FFS hospital were re-hospitalised for any reason (35% vs. 17.5%; p = 0.01), re-admitted to acute-care institutions (11.7% vs. 5.2%; p = 0.014), not satisfied with the discharge process (15.3% vs. 9.7%; p = 0.02), showed problems with self-care (93.8% vs. 88%; p = 0.03) and usual activities (79.3% vs. 76%; p = 0.02).

DISCUSSION: This study suggested that the AP-DRG hospital showed higher patient satisfaction regarding discharge, lower re-hospitalisation rates and shorter LOS partly explained by a lower burden of co-morbidities and disease severity. This study needs validation in a larger cohort of patients and at multiple time points.


  1. Services CfMaM. National Health Expenditures 2010 Highlights. 2012.
  2. Office SFS. Health care costs and financing in 2010. 2012.
  3. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”. JAMA. 2011;306(16):1782–93.
  4. Carratala J, Fernandez-Sabe N, Ortega L, Castellsague X, Roson B, Dorca J, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142(3):165–72.
  5. Donaldson C, Magnussen J. DRGs: the road to hospital efficiency. Health Policy. 1992;21(1):47–64.
  6. Davis C, Rhodes DJ. The impact of DRGs on the cost and quality of health care in the United States. Health Policy. 1988;9(2):117–31.
  7. Rosenthal MB. Beyond pay for performance – emerging models of provider-payment reform. N Engl J Med. 2008;359(12):1197–200.
  8. Rosenthal MB. What works in market-oriented health policy? N Engl J Med. 2009;360(21):2157–60.
  9. Fischer, Wolfram. Die DRG Familie. 2008. Available at:
  10. Pretto M, Spirig R, Kaelin R, Muri-John V, Kressig RW, Suhm N. Outcomes of elderly hip fracture patients in the Swiss healthcare system: A survey prior to the implementation of DRGs and prior to the implementation ofa Geriatric Fracture Centre. Swiss Med Wkly. 2010;140:w13086.
  11. Schuetz P, Albrich WC, Suter I, Hug BL, Christ-Crain M, Holler T, et al. Quality of care delivered by fee-for-service and DRG hospitals in Switzerland in patients with community-acquired pneumonia. Swiss Med Wkly. 2011;141:w13228.
  12. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005;43(3):203–20.
  13. Schrag A, Selai C, Jahanshahi M, Quinn NP. The EQ-5D – a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2000;69(1):67–73.
  14. Dodd S, Bassi A, Bodger K, Williamson P. A comparison of multivariable regression models to analyse cost data. J Eval Clin Pract. 2006;12(1):76–86.
  15. Grundlageninformationen zur Vergütung mit APDRG-Fallpauschalen. Available at:
  16. Busato A, von Below G. The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health Res Policy Syst. 2010;8:31.

Most read articles by the same author(s)

1 2 3 > >>