title: Impact of the DRG-based reimbursement system on patient care and professional practise: perspectives of Swiss hospital physicians.
abstract: OBJECTIVE
  The reimbursement system SwissDRG sets incentives for hospitals and providers to treat patients in a cost-efficient way. Arising conflicts between the commitment to the patient's well-being and the economic interests of the hospital can lead to an impairment of quality and equity of health care. We developed and used a monitoring tool to evaluate ethically relevant aspects related to DRGs by surveying physicians.
  
  
  METHODS
  We surveyed a random sample of physicians working in Swiss hospitals, exploring potentially positive and negative effects of DRGs on patient care.
  
  
  RESULTS
  A total of 382 physicians completed the questionnaire (response rate 47%). More than 90% judged quality of health care "very good" or "rather good", and 83% were satisfied with their job. The majority of physicians gave more consideration to economic issues in their clinical practise than they would have liked and had experienced various forms of over- and under-provision over the past six months. Overall, physicians considered patient-orientation deteriorating since the introduction of DRGs with no gains in efficiency. Professional principles could not be applied in all instances.
  
  
  CONCLUSIONS
  Two years after the introduction of SwissDRG the quality of patient care and the job satisfaction is rated as good by most physicians. However, quality of care could be seriously compromised if more economic pressure is put on physicians in the future. Careful monitoring is needed to ensure that the needed focus on cost-containment and sustainability does not come at the expense of the high performance of the Swiss health care system.
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Margrit
authors: M
authors: Fässler
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Verina
authors: V
authors: Wild
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Caroline
authors: C
authors: Clarinval
authors: Institute of Social and Preventive Medicine, Biostatistics, Zurich, Switzerland.
authors: Alois
authors: A
authors: Tschopp
authors: Medical Directorate, UniversitätsSpital, Zürich, Switzerland.
authors: Jana Alexandra
authors: JA
authors: Faehnrich
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Nikola
authors: N
authors: Biller-Andorno
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003363:Cost Control; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D062489:Health Impact Assessment; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D005791:Patient Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000941:ethics*; D013557:Switzerland