General Information

Sinergia Project funded by Swiss National Science Foundation (SNSF)

Aims of the research project
The project aims to develop indicators and instruments that can help assess the impact of DRGs on patient care and professional practice.

Background
Diagnosis Related Groups (DRGs) have been introduced in Swiss in-patient hospitals in 2012, based on a revision of the Swiss Health Insurance Law (KVG) in 2007. The new reimbursement system includes an incentive for health care professionals to concentrate on the main diagnosis of a patient. DRGs will also provide an incentive for physicians to discharge patients in an efficient manner. DRGs were developed in the USA in the 1960s and have subsequently been implemented in various countries, among them Australia and Germany. Several Swiss cantons have used DRGs for a number of years already.

The implementation of cost-containment structures like DRGs – meant to promote an efficient use of resources – has been controversial. A broad discussion on how to ethically allocate scarce health care resources has been ongoing for decades. There is an evolving consensus that public health care resources are limited and their well-considered use is not only justifiable, but morally required. However, physicians or nurses working in structures that set incentives for cost-containment may perceive a conflict of interest: wanting to provide the best possible care to their patient on the one hand and wanting to be loyal to their institution (or health care system) and its economic viability on the other. Compromised quality of patient care, less equitable access to health care services, shifting delivery of health care to inadequately prepared institutions such as nursing homes, and decreasing job satisfaction among nurses and physicians are being projected if DRGs are being implemented.

Since DRGs are based on an incentive system that directly affects the behavior of health care workers and given that maintaining the quality and equity of health care systems is a genuine concern to many countries, it would seem that thorough analyses of the effects of DRGs are regarded as urgently needed and highly desirable. Yet, there has been no systematic scientific evaluation of the implementation of DRGs. Up to now no country has developed comprehensive evaluation and monitoring tools that address medically, ethically and legally relevant aspects. The research group will take up this gap. The group brings together expertise in the areas of medical ethics, law, nursing science, health services research and – through its network of consulting experts – health economics, policy-making and management.

Methodology
The project focuses on three themes: 1) quality of health care (including also patient satisfaction), 2) access to health care and 3) job satisfaction of nurses and physicians (including also the perceived autonomy at work and the compatibility of working conditions with health care worker’s codes of ethics). The five subprojects (Medical Ethics, Law, Nursing Science, Health Services Research I and II) will use different methodological tools, such as qualitative interviews, quantitative surveys, analysis of health care monitoring instruments. The project will be coordinated by the Institute of Biomedical Ethics, University of Zurich. Regular meetings and workshops will be organized in order to achieve the best cooperation and synergies possible between the subgroups, external experts and stakeholders.

Nikola Biller-Andorno / Verina Wild, Nov. 2010