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

Original article

Vol. 145 No. 0708 (2015)

Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) – a potential model for monitoring and evaluating healthcare reform

  • Verina Wild
  • Fourie Carina
  • Regula Frouzakis
  • Caroline Clarinval
  • Margrit Fässler
  • Bernice Elger
  • Thomas Gächter
  • Agnes Leu
  • Rebecca Spirig
  • Michael Kleinknecht
  • Dragana Radovanovic
  • Corine Mouton Dorey
  • Bernard Burnand
  • John-Paul Vader
  • Jean-Marie Januel
  • Nikola Biller-Andorno
  • The IDoC group
DOI
https://doi.org/10.4414/smw.2015.14034
Cite this as:
Swiss Med Wkly. 2015;145:w14034
Published
08.02.2015

Abstract

QUESTIONS UNDER STUDY: The starting point of the interdisciplinary project “Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice” (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment.

METHODS: Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes.

RESULTS: Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined.

CONCLUSIONS: Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.

References

  1. Wiley M. From the origins of DRGs to their implementation in Europe. In: Busse R, Geissler A, Quentin W, Wiley M, editors. Diagn.-Relat. Groups Eur. – Mov. Transpar. Effic. Qual. Hosp., Open University Press; 2011, p. 3–7.
  2. Langenbrunner J, Cashin C, O’Dougherty S, World Bank. Designing and implementing health care provider payment systems how-to manuals. Washington, D.C.: World Bank; 2009.
  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. Wild V, Pfister E, Biller-Andorno N. Ethical research on the implementation of DRGs in Switzerland – a challenging project. Swiss Med Wkly. 2012;142:w13610.
  5. Bundesamt für Gesundheit (BAG). Allgemeine Informationen zum Krankenversicherungsgesetz (KVG) 2012.
  6. Brügger U. Impact of DRGs: Introducing a DRG reimbursement system: A literature review. SGGP Reihe. Schweizerische Gesellschaft f. Gesundheitspolitik. 2010.
  7. Geissler A, Quentin W, Scheller-Kreinsen D, Busse R. Introduction to DRGs in Europe: Common objectives across different hospital systems. In: Busse R, Geissler A, Quentin W, Wiley M, editors. Diagn.-Relat. Groups Eur. – Mov. Transpar. Effic. Qual. Hosp., Open University Press. 2011, p. 9–21.
  8. 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.
  9. Dougherty CJ. Cost containment, DRGs, and the ethics of health care. Ethical perspectives on prospective payment. Hastings Cent Rep. 1989;19(1):5–11.
  10. Busse R, Stargardt T, Schreyogg J. Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany: methodologies and criteria. Eur J Health Econ. Suppl;2005: p. 30–6.
  11. Powderly KE, Smith E. Cost containment, DRGs, and the ethics of health care. The impact of DRGs on health care workers and their clients. Hastings Cent Rep. 1989;19(1):16–8.
  12. Gaudine A, LeFort SM, Lamb M, Thorne L. Ethical conflicts with hospitals: The perspective of nurses and physicians. Nursing Ethics. 2011;18(6):756–66.
  13. Bentzen G, Harsvik A, Brinchmann BS. “Values That Vanish into Thin Air”: Nurses’ Experience of Ethical Values in Their Daily Work. Nursing Research and Practice, vol. 2013, Article ID 939153, 8 pages, 2013. doi:10.1155/2013/939153
  14. Daniels N. Just health: meeting health needs fairly. Cambridge University Press. 2008.
  15. Daniels N, Light D, Caplan R. Benchmarks of Fairness for Health Care Reform. Oxford University Press. New York. 1996.
  16. Daniels N. Toward ethical review of health system transformations. Am J Public Health. 2006;96(3):447–51.
  17. Fourie C, Biller-Andorno N, Wild V. Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: A matrix of ethical implications. 2013 Dec 5. pii: S0168–8510(13)00311–4. doi: 10.1016/j.healthpol.2013.11.014. [Epub ahead of print]
  18. Organisation for Economic Co-operation and Development (OECD). OECD Reviews of Health Systems – Switzerland (2011). OECD. 2011.
  19. http://www.oecd.org/newsroom/healthswitzerlandshealthsystemishigh-performingbutmustprepareforthefuture.htm
  20. Reinhardt UE. The Swiss health system: regulated competition without managed care. JAMA. 2004;292(10):1227–31.
  21. Herzlinger RE, Parsa-Parsi R. Consumer-driven health care: lessons from Switzerland. JAMA. 2004;292(10):1213–20. http://www.ncbi.nlm.nih.gov/pubmed/15353534
  22. IDoC Project; http://www.ethik.uzh.ch/ibme/forschung/drg.html
  23. Faessler M, Wild V, Clarinval C, Tschopp A, Faehnrich JA, Biller-Andorno N. Impact of the DRG-based reimbursement system on patient care and professional practice: perspectives of Swiss hospital physicians. Swiss Med Wkly. 2015;145:w14080 http://www.smw.ch/content/smw-2015-14080/.
  24. Leu A, Gächter T, Elger B. 365 Tage SwissDRG – Anreize, Instrumente, Wirkungen in: hill Zeitschrift für Recht und Gesundheit, Zürich, 2013; 95: https://hill.swisslex.ch http://www.ethik.uzh.ch/ibme/forschung/drg.html.
  25. Leu A, Gächter T, Elger B. Findet unter SwissDRG eine Minderversorgung vulnerabler Patientengruppen statt? Manuscript in preparation for submission.
  26. Leu A, Gächter T, Elger B. (2014) SwissDRG: Missbrauchsgefahr bei der Datenweitergabe an Krankenversicherer? Erwartungen und Entwicklungen, in: Jusletter März 2014.
  27. Leu A. Der Einfluss von SwissDRG auf die vulnerablen Patientengruppen in Spitälern in der Schweiz: ethische Kriterien und rechtliches Korrelat. Monography in preparation for submission.
  28. Mayring, P. Qualitative Inhaltsanalyse: Grundlagen und Technik (10., neu ausgestattete Auflage ed.). Weinheim, Basel: Beltz; 2008.
  29. Pope C, Ziebland S, Mays N. Qualitative research in health care: Analysing qualitative data. BMJ. 2000;320:114–6.
  30. Corley MC. Moral distress of critical care nurses. Am J Crit Care. 1995;4(4):280–5.
  31. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422–9.
  32. Kleinknecht-Dolf M, Frei IA, Spichiger E, Müller M, Martin JS, Spirig R. Moral distress in nurses at an acute care hospital in Switzerland: Results of a pilot study. Nur Ethics. 2015;22(1):77–90.
  33. Kleinknecht-Dolf M, Spichiger E, Frei IA, Müller M, Martin JS, Spirig R. Monitoring von Pflegekontextfaktoren: Erste deskriptive Studienresultate der schweizerischen DRG Begleitforschung Pflege. Coming forth in "Pflege".
  34. Schubert M, Glass TR, Clarke SP, Schaffert-Witvliet B, de Geest S. Validation of the Basel Extent of Rationing of Nursing Care Instrument. Nursing Research. 2007;56(6):416–24.
  35. Rettke H, Frei IA, Horlacher K, Kleinknecht-Dolf M, Spichiger E, Spirig R. «Arbeiten mit Patienten – Zusammenarbeit im Team», Ergebnisse aus den Fokusgruppeninterviews der DRG-Begleitforschung Pflege. 2014. Coming forth in "Pflege".
  36. Busse R, Nimptsch U, Mansky T. Measuring, monitoring, and managing quality in Germany’s hospitals. Health Aff (Millwood). 2009;28(2):w294–304.
  37. Gharacholou SM, Lopes RD, Alexander KP, Mehta RH, Stebbins AL, Pieper KS, et al. Age and outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: findings from the APEX-AMI trial. Arch Intern Med. 2011;171(6):559.
  38. D’Ascenzo F, Gonella A, Quadri G, Longo G, Biondi-Zoccai G, Moretti C, et al. Comparison of Mortality Rates in Women Versus Men Presenting With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2011;107(5):651–54.
  39. Radovanovic D, Seifert B, Urban P, Eberli FR, Rickli H, Bertel O, et al., on behalf of the AMIS Plus Investigators. Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002–2012. Heart. 2014;100:288–94.
  40. Mercado-Martinez J, Rivera-Fernandez R, Aguilar-Alonso E, Garcia-Alcantara A, Estivill-Torrull A, Aranda-Leon A, et al., Grupo A. APACHE-II score and Killip class for patients with acute myocardial infarction. Intensive Care Med. 2010;36(9):1579–86.
  41. Internal IDoC-workshops. http://www.ethik.uzh.ch/ibme/forschung/drg/internal-idoc-workshops.html (last accessed July 11 2014)
  42. Crossing the Quality Chasm: A New Health System for the 21st Century. Committee on Quality of Health Care in America. Institute of Medicine, National Academy Press. Washington, D.C. 2001
  43. Institute of Medicine: Best Care at Lower Cost – The Path to Continuously Learning Health Care in America. Washington, D.C. 2013.
  44. Spirig R, Spichiger E, Martin JS, Frei IA, Müller M, Kleinknecht M. Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol. GMS German Medical Science. 2014;12:1–13.
  45. Kleinknecht-Dolf M, Grand F, Spichiger E, Müller M, Martin JS, Spirig R. Complexity of nursing care in acute care hospital patients: Results of a pilot study with a newly developed questionnaire. Scand J Car Sci. 2014;1–12.

Most read articles by the same author(s)

1 2 3 4 > >>