SwissDRG (Inpatient Case-based Flat Rates)

Concept and Legal Basis

With the revision of hospital financing, Switzerland introduced service-related case flat rates for acute somatic inpatient treatment on 1 January 2012 (Art. 49 para. 1 KVG). The basis is the nationally uniform tariff structure SwissDRG, maintained by SwissDRG AG, whose shareholders are the cantons (GDK), the hospitals (H+), the insurers and the UVG Medical Tariff Commission. Each case is assigned, based on principal diagnosis, secondary diagnoses, procedures, age and length of stay, to a diagnosis related group with a cost weight. Multiplied by the base rate negotiated for each hospital, this yields the remuneration; length-of-stay outliers are corrected through surcharges and deductions. Psychiatry (TARPSY, since 2018) and rehabilitation (ST Reha, since 2022) have their own day-based flat-rate systems.

Cost Split and Hospital Planning

The case rate is financed on a dual-fixed basis: under Art. 49a para. 2 KVG the canton of residence pays at least 55 % and the health insurer at most 45 % of the remuneration, with the cantons setting their share annually. Reimbursement by basic insurance requires the hospital to be listed on the cantonal hospital list (Art. 39 KVG); insured persons may choose freely among listed hospitals throughout Switzerland but, for elective out-of-canton treatment without medical reasons, bear the difference to the tariff of their canton of residence. The flat rates cover services in the general ward; additional services such as single rooms or free choice of physician are financed through hospital supplementary insurance under the VVG and priced separately.

Country Comparison and Practice Note

Germany has operated the G-DRG system since 2003, since 2020 as aG-DRG with nursing staff costs carved out, and supplemented since the 2025 hospital reform by a reserve-capacity financing component; Austria has remunerated hospitals since 1997 through performance-oriented hospital financing (LKF) with a points system funded by the regional health funds. For insurers and brokers SwissDRG matters because case rates create incentives to shorten stays and shift care to the outpatient setting, which shows in the cost structure of basic and supplementary insurance as well as UVG medical costs.