Diagnosis Related Groups (DRGs); prospective payment system; conflicts of interest; indicators; hospital reimbursement; medical ethics; law; nursing science; health care services research; quality management; patient-centered care; professional practice; cost-containment in health care
Leu Agnes, Gächter Thomas, Elger Bernice (2013), 365 Tage SwissDRG: Anreize, Instrumente, Wirkungen, in Hill: Zeitschrift für Recht und Gesundheit
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Jin Pingyue, Biller-Andorno Nikola, Wild Verina (2013), Cost containment methods for hospital reimbursement in China and ethical tensions, in Asian Bioethics Review
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Staudacher Diana, Kleinknecht Michael, Spirig Rebecca (2013), Erste Resultate aus der DRG-Begleitforschung Pflege: Das Motto für die Pflege unter DRG: Risiken erkennen – rechtzeitig handeln, in Competence
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Bastami Sohaila, Wild Verina (2011), Empirische Untersuchungen zu DRG und Managed Care in den USA, in Biller-Andorno Nikola, Pfister Eliane, Wild Verina (ed.), 47-61.
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Spirig Rebecca, Staudacher Diana, Rettke Horst, Kleinknecht Michael (2011), Wie können DRG die Pflege an Schweizer Spitälern beeinflussen?, in Pfister Eliane, Biller-Andorno Nikola, Wild Verina (ed.), 17-24.
Jin Pingyue, Biller-Andorno Nikola, Wild Verina, Ethical implications of case-based payment in China: A systematic analysis, in Developing World Bioethics
Fourie Carina, Biller-Andorno Nikola, Wild Verina, Systematically Evaluating the Impact of Diagnosis-Related Groups (DRGs) on Health Care Delivery: A Matrix of Ethical Implications, in Health Policy
As stipulated by the partial revision of the Federal Law on Health Insurance, Diagnosis Related Groups (DRGs) will be introduced as a prospective reimbursement system in Swiss in-patient hospital care by 2012, replacing the previous fee-for-service arrangements. This decision has caused considerable controversy among the different stakeholders, due to the diverging appraisals of what will happen when DRGs are introduced as economic management tools on a national scale. On the positive side, DRGs are expected to promote transparency and efficiency while helping to contain health care costs. On the negative side, 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. Although the introduction of DRGs is supposed to be accompanied by an assessment of its economic effects and its consequences for health care quality, it is quite obvious that a narrow focus on cost efficiency and patient safety will not suffice to fully evaluate the concerns raised by the skeptical voices.To develop more comprehensive evaluation and monitoring tools that can address a spectrum of ethical and legal concerns about DRGs is a complex task that requires input from various disciplines. The research group assembled in the context of this proposal is uniquely positioned to carry out this task. It 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. Ongoing pilot projects conducted by members of the group have already produced valuable insights and have identified relevant stakeholders (representing physicians, nurses, patients, hospital administrations, health insurers, the Swiss DRG cooperation, government officials and politicians). This will allow the project to proceed swiftly in the development of qualitative and quantitative tools as well as in the organization of workshops that will further methodological and normative discussions.The project will focus on three themes: 1) quality of health care (understood in a more comprehensive sense, including patient satisfaction), 2) access to health care and 3) job satisfaction of nurses and physicians (including parameters such as perceived autonomy at work and the compatibility of working conditions with health care worker’s individual or professional codes of ethics). It will provide empirical data on selected quality indicators as well as data on the perspectives of physicians, nurses and hospital administrators on the introduction of DRGs. These data will be compared to expectations raised in the literature and in expert and stakeholder interviews. The timing of the project (from fall 2010 through fall 2013) is ideal for this purpose, as it will allow baseline data to be gathered before the nationwide introduction of DRGs, while drawing on previous experiences with DRGs in Germany as well as in some Swiss cantons. It will also cover the early implementation phase of the DRG system, which can help identify potential causal factors triggering certain changes (e.g. shortened duration of hospital stays). Beyond the empirical data, the project will provide a critical analysis of the ethical and legal issues involved, and will provide a set of instruments, together with recommendations for future evaluation and monitoring. The methodological knowledge regarding the challenges and limits of assessing the impact of DRGs can also inform the assessment of other future health policy changes. Finally, the project expects to provide impulses for larger normative discussions on themes such as the tension between fair access to high quality health care, professional autonomy and cost-efficiency.