title: Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: an observational study.
abstract: BACKGROUND
  Reimbursement for inpatients in Switzerland differed among states until 2012. Some hospitals used diagnosis related groups (DRG) and others used fee-for-service (FFS). We compared length of hospital stay (LOS), patient satisfaction and quality of life between the two systems before a nation-wide implementation of DRG.
  
  
  METHODS
  In a prospective, two-centre observational cohort study, we identified all patients with a main diagnosis of either community-acquired pneumonia, exacerbation of chronic pulmonary obstructive disease, acute heart failure or hip fracture from January to June 2011 and performed a systematic questionnaire survey 2-4 months after hospital discharge.
  
  
  RESULTS
  Of 1,093 inpatients, 450 were included. Mean age was 71.1 (±SD 19.5) years (48% male). Patients in the FFS hospital were older (mean age 74.8 vs. 65.2 years; p <0.001) and suffered from more co-morbidities. Mean LOS was 9 days and shorter in the all-patient DRG (AP-DRG) hospital (unadjusted mean 8.2 vs. 9.5 days, p = 0.04). After multivariate adjustment, no significant difference in LOS was found (p = 0.24). More patients from the FFS hospital were re-hospitalised for any reason (35% vs. 17.5%; p = 0.01), re-admitted to acute-care institutions (11.7% vs. 5.2%; p = 0.014), not satisfied with the discharge process (15.3% vs. 9.7%; p = 0.02), showed problems with self-care (93.8% vs. 88%; p = 0.03) and usual activities (79.3% vs. 76%; p = 0.02).
  
  
  CONCLUSIONS
  This study suggested that the AP-DRG hospital showed higher patient satisfaction regarding discharge, lower re-hospitalisation rates and shorter LOS partly explained by a lower burden of co-morbidities and disease severity. This study needs validation in a larger cohort of patients and at multiple time points.
authors.affiliation: Division of Internal Medicine, University Hospital Basel, Switzerland. noemi.weissenberger@stud.unibas.ch
authors.forename: Noemi
authors.initials: N
authors.lastname: Weissenberger
authors.forename: Désirée
authors.initials: D
authors.lastname: Thommen
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.forename: Christoph
authors.initials: C
authors.lastname: Reemts
authors.forename: Thomas
authors.initials: T
authors.lastname: Holler
authors.forename: Juerg A
authors.initials: JA
authors.lastname: Schifferli
authors.forename: Martin
authors.initials: M
authors.lastname: Gerber
authors.forename: Balthasar L
authors.initials: BL
authors.lastname: Hug
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D018450:Disease Progression; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure; D006620:Hip Fractures; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011014:Pneumonia; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive; D011788:Quality of Life; D012648:Self Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013557:Switzerland; D062606:Tertiary Care Centers / Q000706:statistics & numerical data