A new case-mix based payment system for the psychiatric day care sector in Switzerland: proposed methods for developing the tariff structure

Abstract

In many European countries, there has been a shift towards outpatient psychiatric care over the past decades, as it is more cost-effective and resources for health care are limited. Switzerland, however, still has a high number of inpatient psychiatric hospital beds and a comparatively high length of stay. The existence of differing remuneration systems between inpatient and outpatient settings creates a distortion of incentives regarding the choice of treatment setting and an inefficient allocation of resources. To address this issue, a new tariff structure for day care treatment is suggested, based on the development and evaluation of the DRG-based inpatient remuneration system tariff psychiatry (TARPSY), using inpatient data from 2018, 2019, and 2021. The method involves three steps: estimating the day care treatment setting potential by delimiting cases from the inpatient patient data, adjusting the costs of this subset to approximate a day care treatment setting, and calculating daily cost weights based on the existing cost weights. The resulting reimbursements are about half of the inpatient reimbursements.To implement the tariff structure, this paper suggests that a number of framework conditions and regulations must be defined or modified. Additionally, subsequent cost data surveys from the day care setting can be incorporated into the calculation as part of a learning system. The remuneration system outlined in this paper could potentially be applied for day care psychiatry in other countries with DRG systems, especially in countries with conflicting remuneration systems in the inpatient and out patient sector.