Inpatient-outpatient transitions

Central to this project is the interface between inpatient and outpatient care: what care do elderly and sick people receive in hospital and subsequently in their home environment?

Basis

Increasing life expectancy is resulting in an ageing society. This demographic change is not just sparking a debate on the ability to finance public health: it is also raising the broader question of suitable care in inpatient and outpatient scenarios within the legal framework. Containing costs is a central concern of today's modern healthcare systems, to enable continued provision of good quality, affordable healthcare.

As part of large-scale healthcare reform, flat rate payments (SwissDRG) were introduced in Switzerland in 2012 to pay for inpatient services in acute hospitals. A previous study showed how hospitals are responding to the new tariff system. The results provide evidence that the change in commercial incentives in inpatient care in hospitals is triggering a displacement of services. Services with a high proportion of care are thus less appealing to hospitals. Sometimes, inpatient acute care in hospitals ends earlier these days, or is delegated to care at home. Furthermore, since 2011, new legal principles have applied to supplementary AHV/IV (old-age and survivors' / disability insurance) benefits. There has been little research into the interaction between the two financing strategies.

Project

The interdisciplinary project “inpatients-outpatients transitions in the era of DRGs: the legal framework and current practice” adopts a legal, medical and sociological approach and is a collaborative project with the University of Zurich (Prof. Dr. iur. Thomas Gächter),The University of Basel (Prof. Dr. med. Bernice Elger) and Careum Research (Prof. FH Dr. iur Agnes Leu). Building on previous projects should address a gap in research. So far, no findings have been established on the legal aspects and consequences of overlapping new payment rules for inpatient and outpatient care. The project pursues three main objectives:

  1. It investigates whether the legal conditions are effective, enabling the interaction of both reformed systems of finance and whether the applicable rules provide sufficiently clear guidelines.
  2. It investigates those factors influencing healthcare and support following acute care. Another important question is whether and to what extent both reformed financing systems affect the decisions of service providers and insured persons. To conduct this investigation, interviews are being conducted with experts and interest groups (health professionals, politicians, patient organisation representatives) regarding the implementation of the new legal conditions in five different cantons (ZH, GE, LU, BS, TI). Finally, patients are also asked about their experiences and satisfaction with the decision-making process.
  3. This should clarify whether legislative measures are proven with respect to the individual entitlement, enshrined within the constitution, to treatment for illnesses and associated care. Is there a risk that the new legal framework is causing patient decisions to be made that result in a reduction of care for or discrimination against particularly vulnerable groups?


The research team is working in conjunction with national and international experts from the fields of social security, law, medicine, medical ethics, health economics and sociology. The research findings are published in national and international journals and also included in the Dissertation by Yvonne Padrutt, Mlaw (Prof. Dr. iur. Thomas Gächter, University of Zurich).

Project team

University of Zurich: Prof. Dr. iur. Thomas Gächter (Institute of Law, Professor of Constitutional, Administrative and Social Security Law)
University of Basel: Prof. Dr. med. Bernice Elger (Institute for Biomedical Ethics)
Careum Research: Prof. FH Dr. iur. Agnes Leu

External funding

Swiss National Science Foundation SNSF, CR13I1_156274/1

Duration

October 2015–October 2018

Partners in practice

Publications

Leu, A., Gaechter, T., & Elger, B. (2013). 365 Tage SwissDRG – Anreize, Instrumente, Wirkungen. hill Zeitschrift für Recht und Gesundheit, (95). Online verfügbar unter https://hill.swisslex.ch

Leu, A. (2015). Einfluss der SwissDRG auf die vulnerablen Patientengruppen in der Schweiz: Ethische Kriterien und rechtliches Korrelat. Berlin: De Gruyter. Verlag

Leu, A., Gächter, T., & Elger, B. S. (2015). Swiss DRG: Missbrauchsgefahr bei der Datenweitergabe an Krankenversicherer?: Erwartungen und Entwicklungen. Schweizerische Zeitschrift für Gesundheitsrecht RSDS/SZG, 83-96. Volltext

Leu, A., Gächter, T., & Elger, B. (2015). Führt SwissDRG zu einer Minderversorgung vulnerabler Patientengruppen? Pflegerecht, 4 (1), 9–14. PDF

Wild, V., Fourie, C., Frouzakis, R., Clarinval, C., Leu, A. et al. (2015). Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) – a potential model for monitoring and evaluating health care reform. Swiss Medical Weekly, 145, w14034. doi: 104414/smw.2015.14034