[From pay-for-effort to pay-for-performance--an analysis of the Swiss health care system with focus on the inpatient sector].
BACKGROUND
The Swiss health care system is facing the implementation of lump compensation in the form of diagnosis related groups from 2010 on. In addition there is an increasing discussion about the quality of health care in the media. We have analyzed current remuneration in Swiss health care and their steering effects on providers in order to deduct future developments in Swiss health care remuneration.


METHODS
Based on the remuneration contracts and tariff regularities at the Basel University Hospital we conducted an internet and literature search. The identified Swiss remuneration systems were classified after remuneration scales and remuneration item using a typology of performance-related remuneration systems. The steering effects of the remuneration systems on the providers were deducted.


RESULTS
Remuneration scales can be classified in <<costs incurred>>, <<standardized costs>> or <<negotiated costs>>. Remuneration items can be classified in <<activities>>, <<cases>> or <<outcome oriented cases>>. Remuneration systems can lead to increased or decreased services or to patient selection. In the Swiss health care system we find a trend away from traditional <<pay-for-effort>> to <<pay-for-performance>> remuneration systems. In that context diagnosis related groups are identified as an intermediate step in the development of remuneration systems.


CONCLUSIONS
Future developments of medical remuneration in terms of a consideration of quality of medical performance and negotiated costs seem likely in Switzerland in the long term. Both, economics and quality should be considered adequately in a health care remuneration system.
Rieger
Ulrich M
UM
Forschungsgruppe Spitalmanagement, Institut für Chirurgische Forschung und Spitalmanagement, Basel. ulrich.rieger@uki.at
Prengel
A
A
Burla
S
S
Rüdiger
M
M
Pierer
G
G
Heberer
M
M
D000553:Ambulatory Care / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D018588:Fee-for-Service Plans; D005858:Germany; D019538:Health Care Surveys; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007348:Insurance, Health / Q000191:economics; D007349:Insurance, Health, Reimbursement; D020407:Internet; D012051:Reimbursement Mechanisms; D012052:Reimbursement, Incentive; D013557:Switzerland