Free choice of hospital/diagnosis-related groups (DRG)

The new health insurance law (KVG), in effect since January 1, 2012, regulates the financing of Swiss hospitals. It includes the free choice of hospital: for example, patients can be treated at the University Hospital Zurich (UHZ) even if they do not live in the Canton of Zurich. However, not all costs for treatment outside the canton of residence will be fully covered by basic insurance.

The key question is as follows: does the canton of residence and the basic insurance cover the treatment costs in full, or must the patient cover some of the costs themselves?

You can refer patients to the University Hospital Zurich without incurring additional costs (excluding franchise and deductible) when at least one of the following applies:

  • The UHZ appears on the hospital list of the canton of residence for the treatment required.
  • The patient has supplementary insurance (semi-private or private) or has additional coverage for treatment in "general wards throughout Switzerland".
  • The cantonal medical officer of your canton has granted an approval of assumption of costs (Kostengutsprache) upon your request.

If none of these conditions are met, the patient must pay the difference between the University Hospital tariff and the canton of residence reference tariff.


The repercussions of DRG

How does DRG influence the choice of hospital?

Under the new KVG health insurance law, patients may freely choose a hospital in Switzerland and can be treated, for example, at the University Hospital Zurich even if they do not live in the Canton of Zurich. However, not all treatments received outside the canton of residence are fully covered by health insurance.

How does DRG affect the collaboration between referring physicians and the UHZ?

DRG is a financing system for the billing of inpatient treatment. It has no direct impact on the collaboration between you and our hospital.

Will DRG affect the length of patients' stay?

No, the average time spent at the University Hospital Zurich is already included in the DRG specifications.

Does DRG influence the form of hospitalization?

The decision whether to provide treatment on an outpatient or inpatient basis lies with the chief physician of our hospital. This is influenced primarily by medical advances which, for example, enable outpatient care. The personal circumstances of the patient also influences the decision.

How does DRG influence discharge planning?

Discharge management plays a central role within the DRG framework. The move to a rehabilitation clinic, a simple transfer to another hospital, or early planned care through Spitex services are aspects which are given special attention. We are well equipped to meet these challenges through the rapid availability of discharge documents and the timely inclusion of aftercare institutions.


Your contact at the University Hospital Zurich

Our Medical Office is available to answer any questions or concerns you may have.

University Hospital Zurich
Medical Office, Department of Medical Controlling
8091 Zurich
medizincontrolling@usz.ch

Links

Cantonal hospital list
Contact persons and approval of assumption of costs (Kostengutsprache) form
Information sheet for doctors (PDF) explains the details and conditions of free choice of hospital