Objective: This study aims to investigate whether specific treatments or combinations of treatments are significantly associated with the profitability of Swiss acute-care hospitals under the current diagnosis-related group (S-DRG) reimbursement system, while accounting for differences between...

Per Ende 2023 wurden dem Bundesrat die beiden Vorschläge neuer Tarifsysteme für ambulant-medizinische Leistungen zur Genehmigung vorgelegt, welche den in die Jahre gekommenen TARMED ersetzen sollen. Ziel des vorliegenden Berichts ist es, die Vorzüge von ambulanten Pauschalen zu identifizieren...

Background Hospital services are typically reimbursed using case-mix tools that group patients according to diagnoses and procedures. We recently developed a case-mix tool (i.e., the Queralt system) aimed at supporting clinicians in patient management. In this study, we compared the performance...

Hospitals account for 40 % of all healthcare expenditures and play a central role in healthcare provision. Therefore, the way hospitals are payed has major implications for the care they provide. Yet the knowledge about system wide effects of payment reforms is surprisingly thin. This study...

Upcoding in Medicare has been a topic of interest to economists and policy makers for nearly 40 years. While upcoding is generally understood as "billing for services at higher level of complexity than the service actually pro- vided or documented," it has a wide range of definitions within the...

Many OECD countries have replaced per-diem hospital reimbursement with lump sum payments by diagnosis-related groups (DRGs). However, modern DRG systems still allow hospitals to pass on actual treatment costs to payers, which might hinder the efficiency of health care provision. This paper...

Die Finanzierung der allgemeinen Krankenhäuser wurde vor mehr als 15 Jahren auf DRG-Fallpauschalen umgestellt (DRG: Diagnosis Related Groups). Ab dem Jahr 2003 konnten Krankenhäuser die neuen Fallpauschalen zunächst freiwillig anwenden, ab 2004 war die Abrechnung mit Fallpauschalen...