A new case-mix based payment system for the psychiatric day care sector in Switzerland: Proposed methods for the development of an adequate tariff structure

Samuel Noll ^a, Mischa Hintermann ^a, Simon Hölzer ^a

Introduction
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 average 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. The casemix office, SwissDRG Inc. has proposed a new remuneration system for day care treatment that addresses these issues¹.

Methods
In Switzerland, the TARPSY tariff structure has governed the remuneration of inpatient psychiatric services since 2018². The proposed tariff structure for day care treatment was assessed using data from the inpatient sector for the years 2018, 2019, and 2021³. 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.

Results
A daily cost weight could be calculated for 21 cost groups in psychiatry. These cost weights vary between 46 and 53% of the corresponding inpatient (daily) cost weight (TARPSY Version 4.0). Thus, the resulting reimbursements in an outpatient setting are estimated to be about half of the inpatient reimbursements.

Discussion
To implement the tariff structure, 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 day care remuneration system 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 outpatient sector.


¹ Noll et al., "A new case-mix based payment system for the psychiatric day care sector in Switzerland: proposed methods for developing the tariff structure", Health Policy, Volume 131, 2023, 104797, ISSN 0168-8510, https://doi.org/10.1016/j.healthpol.2023.104797
² Schneeberger AR, Spring E, Schwartz BJ, Peter T, Seifritz E, Felber E et al. TARPSY: a new system of remuneration for psychiatric hospitalization in Switzerland. 2018; 69(10):1056-1058 https://doi.org/10.1176/appi.ps.201800233
³ The year 2022 could still be added until the presentation.

^a SwissDRG AG, Switzerland

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