Inpatient treatment for severe nonsurgical dermatological disorders: prevalence, care infrastructure and reimbursement in Switzerland

Abstract

Background: Since 2012, Swiss inpatient dermatology is funded through a flat rate payment system based on diagnosis-related groups (DRGs). Objective: To analyze the reimbursement of nonsurgically treated severe disorders of the skin under the system called SwissDRG. Methods: Three retrospective, cross-sectional cohort studies were performed. Data sets were received from the Swiss Federal Office of Statistics (1,285,685 retained records), the five Swiss university hospitals (370,964 retained records) and our center (72,211 retained records). Results: Cases accounted for 0.04% of all hospitalizations nationwide, with 43.7% treated at university hospitals. Treatment at university hospitals produced a mean loss of USD 3,711 per case. Lyell syndrome cases were especially underfunded (mean loss USD 31,906). Extra-county admissions and direct referrals were significant predictors of total inpatient costs (p = 0.019 and p < 0.001, respectively). Conclusions: We suggest grouping Lyell syndrome cases into burn DRGs and evaluating extra-county admissions and direct inpatient referrals as DRG split criteria.