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

Original article

Vol. 144 No. 2526 (2014)

Head-to-head comparison of length of stay, patients’ outcome and satisfaction in Switzerland before and after SwissDRG-Implementation in 2012

  • Désirée Thommen
  • Noemi Weissenberger
  • Philipp Schuetz
  • Beat Mueller
  • Christoph Reemts
  • Thomas Holler
  • Juerg A. Schifferli
  • Martin Gerber
  • Balthasar L Hug
Cite this as:
Swiss Med Wkly. 2014;144:w13972


BACKGROUND: On 1 January 2012 Swiss Diagnosis Related Groups (DRG), a new uniform payment system for in-patients was introduced in Switzerland with the intention to replace a “cost-based” with a “case-based” reimbursement system to increase efficiency. With the introduction of the new payment system we aim to answer questions raised regarding length of stay as well as patients’ outcome and satisfaction.

METHODS: This is a prospective, two-centre observational cohort study with data from University Hospital Basel and the Cantonal Hospital Aarau, Switzerland, from January to June 2011 and 2012, respectively. Consecutive in-patients with the main diagnosis of either community-acquired pneumonia, exacerbation of COPD, acute heart failure or hip fracture were included. A questionnaire survey was sent out after discharge investigating changes before and after SwissDRG implementation. Our primary endpoint was LOS.

RESULTS: Of 1,983 eligible patients 841 returned the questionnaire and were included into the analysis (429 in 2011, 412 in 2012). The median age was 76.7 years (50.8% male). Patients in the two years were well balanced in regard to main diagnoses and co-morbidities. Mean LOS in the overall patient population was 10.0 days and comparable between the 2011 cohort and the 2012 cohort (9.7 vs 10.3; p = 0.43). Overall satisfaction with care changed only slightly after introduction of SwissDRG and remained high (89.0% vs 87.8%; p = 0.429).

DISCUSSION: Investigating the influence of the implementation of SwissDRG in 2012 regarding LOS patients’ outcome and satisfaction, we found no significant changes. However, we observed some noteworthy trends, which should be monitored closely.


  1. Donaldson C, Magnussen J. DRGs: the road to hospital efficiency. Health Policy. 1992;21(1):47–64.
  2. 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.
  3. 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.
  4. 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.
  5. Rosenthal MB. Beyond pay for performance – emerging models of provider-payment reform. N Engl J Med. 2008;359(12):1197–200.
  6. Rosenthal MB. What works in market-oriented health policy? N Engl J Med. 2009;360(21):2157–60.
  7. SwissDRG-AG. Fallpauschalen in Schweizer Spitälern: Basisinformationen für Gesundheitsfachleute. Available from:
  8. Fischer Wolfram. Die DRG Familie. 2008; Available from:
  9. Busse R, Geissler A, Aaviksoo A, Cots F, Hakkinen U, Kobel C, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ. 2013;346:f3197.
  10. Bartkowski R. Length of hospital stay due to DRG reimbursement. Ther Umsch. 2012;69(1):15–21.
  11. Weissenberger N, Thommen D, Schuetz P, Mueller B, Reemts C, Holler T, et al. Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: an observational study. Swiss Med Wkly. 2013;143:w13790.
  12. Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005;24(3):465–88.
  13. BFS, B.f.S. Todesfälle: Anzahl, Entwicklung und Ursachen. 2013; Available from:
  14. BFS, B.f.S. Durchschnittliche Spitalaufenthaltsdauer. Available from:

Most read articles by the same author(s)

1 2 3 > >>