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...

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...

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...

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...