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

Original article

Vol. 150 No. 3536 (2020)

The new remuneration system TARPSY in Swiss psychiatric hospitals: effects on length of stay and readmissions?

Cite this as:
Swiss Med Wkly. 2020;150:w20337



In 2018, Switzerland introduced a nationwide case-based prospective remuneration system (TARPSY), with decreasing daily rates for reimbursement of inpatient care in mental health facilities. Initially, there were concerns that declining daily rates could result in early discharges and increased readmission rates.


We compared length of stay (LOS) and readmission rates for patients in adult and geriatric psychiatry treatment at four psychiatric hospitals between 2017 (the last year with the traditional remuneration system) and 2018 (the first year with TARPSY).


A total of 26,324 treatment episodes of 15,464 patients were analysed. The reduction of average LOS was not statistically significant in the first year after the implementation of TARPSY, neither in adult (mean –0.6 days, 95% confidence interval [CI] –1.6 to 0.4; p = 0.226) nor in geriatric psychiatry (mean −1.6 days, 95% CI −3.8 to 0.7; p = 0.178). When compared with the traditional remuneration system with fixed daily rates, the readmission risk was statistically significantly reduced by −9.1% (95% CI −4.9 to −13.1%; p <0.001) in adult psychiatry but not in geriatric psychiatry (−6.8%, 95% CI −19.2 to 7.4%; p = 0.329).


If being evident at all, the effects of the new remuneration system TARPSY on LOS and readmission rates seem to be small. Concerns that declining daily rates in TARPSY would result in early discharges and increased readmission rates did not prove true in adult and geriatric psychiatry.


  1. Organisation for Economic Co-operation and Delelopment (OECD). Dataset: Health expenditure and financing. Paris: OECD; 2020.
  2. Organisation for Economic Co-operation and Delelopment (OECD). Dataset: Health Care Resources. Paris: OECD; 2020.
  3. Organisation for Economic Co-operation and Delelopment (OECD). Dataset: Health Care Utilisation. Paris: OECD; 2020.
  4. Bundesamt für Statistik (BfS). Kosten des Gesundheitswesens nach Leistungen. Neuchatel: BfS; 2020.
  5. Knapp M, McDaid D, Amaddeo F, Constantopoulos A, Oliveira MD, Salvador–Carulla L, et al. Financing mental health care in Europe. J Ment Health. 2007;16(2):167–80. doi:.
  6. McDaid D. Psychiatric remuneration systems in Europe: an overview. Psychiatrie (Stuttg). 2011;8(1):9–15. doi:.
  7. Lien L. Financial and organisational reforms in the health sector; implications for the financing and management of mental health care services. Health Policy. 2003;63(1):73–80. doi:.
  8. Taube C, Lee ES, Forthofer RN. DRGs in psychiatry. An empirical evaluation. Med Care. 1984;22(7):597–610. doi:.
  9. Schumacher DN, Namerow MJ, Parker B, Fox P, Kofie V. Prospective payment for psychiatry--feasibility and impact. N Engl J Med. 1986;315(21):1331–6. doi:.
  10. Hunter CE, McFarlane AC. DRGs and Australian psychiatry. Aust N Z J Psychiatry. 1994;28(1):114–20. doi:.
  11. Neumaier S, Klose P, Dirschedl P. [Basic knowledge about the current status of the new reimbursement system, the German coding guidelines in psychiatry/psychosomatic medicine and the use of ICD-10-GM/OPS]. Gesundheitswesen. 2012;74(10):678–84, quiz 685–6.
  12. Frick U, Barta W, Binder H. Fallpauschalen in der stationär-psychiatrischen Versorgung - Empirische Evaluation im Land Salzburg [Hospital financing in in-patient psychiatry via DRG-based prospective payment--The Salzburg experience]. Psychiatr Prax. 2001;28:55–62. doi:.
  13. Mason A, Goddard M, Myers L, Verzulli R. Navigating uncharted waters? How international experience can inform the funding of mental health care in England. J Ment Health. 2011;20(3):234–48. doi:.
  14. Klose P, Dirschedl P, Mohrmann M. Fallpauschalen in der Krankenhaus-Psychiatrie der USA [Case payments in hospital psychiatry in the USA. The Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)]. Gesundheitswesen. 2010;72(8-9):487–91. doi:.
  15. Drozd EM, Cromwell J, Gage B, Maier J, Greenwald LM, Goldman HH. Patient casemix classification for medicare psychiatric prospective payment. Am J Psychiatry. 2006;163(4):724–32. doi:.
  16. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system for inpatient psychiatric facilities. Final rule. Fed Regist. 2004;69(219):66921–7015.
  17. Swiss DRGAG. TARPSY 1.0. Definitionshandbuch. Abrechnungsversion 2018 / 2018. Bern: SwissDRG AG; 2018.
  18. Schneeberger AR, Spring E, Schwartz BJ, Peter T, Seifritz E, Felber E, et al. TARPSY: A new system of remuneration for psychiatric hospitalization in Switzerland. Psychiatr Serv. 2018;69(10):1056–8. doi:.
  19. Warnke I, Rössler W, Herwig U. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services. BMC Psychiatry. 2011;11(1):120. doi:.
  20. World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization; 1992.
  21. Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the Nation Outcome Scales (HoNOS): Research and development. Br J Psychiatry. 1998;172(1):11–8. doi:.
  22. Lave JR, Frank RG. Effect of the structure of hospital payment on length of stay. Health Serv Res. 1990;25(2):327–47.
  23. Frank RG, Lave JR. A comparison of hospital responses to reimbursement policies for Medicaid psychiatric patients. Rand J Econ. 1989;20(4):588–600. doi:.
  24. Lave JR, Frank RG, Taube C, Goldman H, Rupp A. The early effects of Medicare’s prospective payment system on psychiatry. Inquiry. 1988;25(3):354–63.
  25. Taube CA, Lave JR, Rupp A, Goldman HH, Frank RG. Psychiatry under prospective payment: experience in the first year. Am J Psychiatry. 1988;145(2):210–3. doi:.
  26. Rupp A, Steinwachs DM, Salkever DS. The effect of hospital payment methods on the pattern and cost of mental health care. Hosp Community Psychiatry. 1984;35(5):456–9. doi:.
  27. Warnke I, Rössler W, Nordt C, Herwig U. Assessing a financial incentive for reducing length of stay of psychiatric inpatients: implications for financing psychiatric services. Swiss Med Wkly. 2014;144:w13991. doi:.
  28. Gesundheitsdirektion. Gesundheitsversorgung 2018. Zürich: Kanton Zürich; 2018.
  29. Gesundheitsdirektion. PSYREC-KTR.Handbuch. Version 8.1. Zürich: Kanton Zürich; 2018.
  30. Bundesamt für Statistik (BfS). Variablen der Medizinischen Statistik. Spezifikationen gültig ab 1.1.2017. Neuchatel: BfS; 2017.
  31. Swiss DRGAG. Regeln und Definitionen zur Fallabrechnung unter TARPSY. Bern: SwissDRG; 2016.
  32. Weltgesundheitsorganisation. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Bern: Hans Huber; 2005.
  33. Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions. Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability. 1967;I:221-33.
  34. Amorim LD, Cai J. Modelling recurrent events: a tutorial for analysis in epidemiology. Int J Epidemiol. 2015;44(1):324–33. doi:.
  35. Morger M, Jäggi J, Stocker D, Kiünzi K. Konzeptstudie zur Untersuchung der Einführung von TARPSY und ST Reha. Studie im Auftrag des BAG. Bern: Büro für arbeits- und sozialpolitische Studien BASS; 2018.
  36. Gesundheitsdirektion. Gesundheitsversorgung 2019. Zürich: Kanton Zürich; 2019.
  37. Zander E, Wyder L, Holtforth MG, Schnyder U, Hepp U, Stulz N. Validity of routine clinical diagnoses in acute psychiatric inpatients. Psychiatry Res. 2018;259:482–7. doi:.

Most read articles by the same author(s)