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Assessing the impact of Diagnosis Related Groups (DRGs) on patient care and professional practice: an interdisciplinary approach
Third-party funded project
Project title Assessing the impact of Diagnosis Related Groups (DRGs) on patient care and professional practice: an interdisciplinary approach
Principal Investigator(s) Biller-Andorno, Nikola
Co-Investigator(s) Elger, Bernice Simone
Spirig, Rebecca
Project Members Leu, Agnes
Organisation / Research unit Ethik / Bio- und Medizinethik (Elger)
Project Website
Project start 01.01.2011
Probable end 31.12.2013
Status Completed

Until today, over hundred hospitals Swiss wide know the APDRG (all patient diagnosis related group). With the Swiss wide introduction of a new hospital financing system – the Swiss DRG – in 2012 the hospitals are reimbursed per case and not per inpatient day. The present project has two parts, a theoretical legal analysis and an empirical part. The empirical part investigates the impact of Swiss and international law in practice. What we intend to do in our project are analysis of legal aspects concerning DRG as a form of rationing and the risk of discrimination. How can DRG create a form of more or less visible rationing? Since DRGs reimburse hospitals per case and not per inpatient day, hospitals will benefit from a high case load of patients who stay less than the average hospitalisation length for a given diagnosis related group. This may lead to forms of cost shifting, including to what is called „bloody exits“. From a legal point of view rationing is problematic because it interferes with fundamental rights of persons. Although Switzerland‘s federal law does not contain a right to health, the fundamental right not to be discriminated against is strongly protected in the Swiss constitution (BV 8), as well as in jurisprudence and other legal provisions. An almost unavoidable consequence of DRG based hospital reimbursement seems patient selection because hospitals intend to minimize the risk of bearing the costs of „outliers“ (means patients who stay longer or require more costly treatment than the average DRG pays).

Project-transversal questions that will also be examined are firstly how decisions in the hospital management concerning health care costs are presently taken, and how much control experts, as well as single hospitals or their managers have about details relevant for just and equal access to health care.

Secondly, the influence of cantonal and or federal law on the decision making of experts and hospital managers will also be studied.

Keywords DRG, Rationing, Discrimination, Law
Financed by Swiss National Science Foundation (SNSF)

Published results ()

  ID Autor(en) Titel ISSN / ISBN Erschienen in Art der Publikation
1525604  Kieser, Ueli; Leu, Agnes  2. St. Galler Tagung zum Gesundheitsrecht : neueste Entwicklungen in Gesetzgebung und Rechtsprechung - Qualität in der Gesundheitsversorgung : Referate der Tagung vom 24. August 2011 in Luzern  978-3-908185-99-4    Publication: Edited Book (Herausgeber eines eigenständigen Buches) 
1029736  Elger, B. S.; Gächter, T.  DRGs und die Gesundheitsversorgung marginaler Gruppen  978-3-03754-052-7 ; 3-03754-052-4  DRG und Ethik  Publication: Book Item (Buchkap., Lexikonartikel, jur. Kommentierung, Beiträge in Sammelbänden etc.) 

Cooperations ()

  ID Kreditinhaber Kooperationspartner Institution Laufzeit - von Laufzeit - bis
2363394  Leu, Agnes  Marckmann, Georg, Prof.  Ludwig-Maximilian-Universität München LMU  01.07.2013  31.12.2013 
1016829  Elger, Bernice Simone  Spirig, Rebecca, Dr., Co-Referee   Abteilung für Klinische Pflegewissenschaft und Entwicklung, University Hospital Zurich  01.01.2011  30.04.2014 
1016830  Elger, Bernice Simone  Radovanovic, Dragana, Dr, Co-Referee  National Registry of Acute Myocardial Infarction in Switzerland  01.01.2011  30.04.2014 
1016831  Elger, Bernice Simone  Vader, John-Paul, Prof., Co-Referee  Faculty of biology and medicine, University of Lausanne   01.01.2011  30.04.2014 

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