Abstract: A review of the initial years of the national tariff structure TARPSY
Samuel Noll a, Rémi Guidon a, Sarah Haag a
Introduction
This paper provides a review of the main developments and challenges encountered in the initial years since the introduction of TARPSY, the national tariff system for psychiatric hospitalization used in Switzerland. TARPSY was first introduced for the remuneration of adult psychiatry in 2018. By 2019 it was extended for use in child and adolescent psychiatry and by 2020 for use in forensic psychiatry. Its development and maintenance is carried out by a non-profit corporation, SwissDRG Inc, which was founded by health insurance companies, healthcare providers and states/cantons. The tariff system is characterized by flat-rate daily payments which are monotonically declining with the length of stay in the psychiatric hospital.
Methods & Results
TARPSY was introduced gradually with a new version released annually. In the first two versions, patients were categorized into 19 patient cost groups (PCGs) based on their main diagnosis as well as further criteria such as complexity and severity of the psychiatric case and performed treatments. The third version of TARPSY introduced additional payments for specialized therapies such as planned trial leave and electroconvulsive therapy. The fourth version added two additional PCGs bringing the total number of PCGs to 21. Facilitating these improvements was the gradually increasing data quality. The number of Swiss hospitals delivering data as well as the number of cases passing plausibility checks increased each year. Additionally, data quality was further improved through the introduction of new psychiatry specific treatment codes (CHOP) by the Swiss Federal Statistical Office in 2018.
Conclusions
The approach with a limited set of diagnostic and procedure codes contributes to a broad acceptance by medical staff and healthcare providers. Overall, TARPSY's wide-ranging acceptance by all stakeholders in Switzerland suggests adapting it for use in other countries and other healthcare settings could be successful.
a SwissDRG, Switzerland
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