Switzerland has the highest health care expenditures in Europe and the second highest worldwide. The continuous rise of cost led to the reform introducing a new hospital payment system based on diagnosis-related groups (DRGs), free hospital choice for patients, dual financing by health insurances and cantons as well as hospital capacity planning. The main aim of these instruments was to curb cost increase while keeping quality and access stable. The reform was decided in 2012, and since then, the range of services offered by 275 hospitals across 596 locations (as of 2023) has been structured through a new planning framework introduced gradually. To date, however, there is only limited knowledge about the effectiveness of this system, particularly regarding care structures, quality, and costs. The research project funded by the Swiss National Science Foundation (SNSF) aims to close these knowledge gaps. The project seeks to comprehensively analyze the effects of hospital planning on service delivery, quality, and costs. It examines whether capacity planning has led to a centralization of care or changes in market concentration. The focus also lies on whether complex treatments have increasingly been concentrated in specialized centers, while basic care has shifted to regional hospitals, and how the level of quality requirements influences these changes. Furthermore, the project evaluates whether the reform has achieved quality improvements, particularly in complex treatments, and whether the new planning has effectively curbed healthcare expenditure increase in the hospital sector.
Prof. Dr. Alexander Geissler, Dr. Justus Vogel, Dr. David Ehlig, Daria Bukanova-Berend, Charlotte Schneider, Carla Walker, Shinan Chen
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Swiss National Science Foundation (SNSF)
October 2024 – September 2027