Patients struggle to understand Swiss hospital bills

Hospital patients in Switzerland are legally entitled to receive a copy of their bill, but the documents remain difficult for many people to decipher, SRF reported in an article by Vittoria Vardanega for SWI swissinfo.ch. The aim of the requirement is to make it possible to check billed services, report errors and understand healthcare costs.

How hospital bills are calculated

Since 2012, acute hospital stays have been billed using a case-based flat rate rather than charges for individual services. SwissDRG developed the tariffs on behalf of the cantons, insurers and hospitals.

After a patient is discharged, their diagnoses and procedures are converted into codes. These codes determine which group of clinically similar cases the patient is assigned to. Each group has a defined cost, which is multiplied by the hospital’s base rate.

Base rates are renegotiated every year and can vary between hospitals. As a result, SwissDRG chief executive Simon Hölzer said the same medical case can produce different costs depending on the institution.

The SwissDRG catalogue makes it possible to trace and recalculate the final bill. It does not, however, show how the patient was assigned to a particular group or code. The bill contains no detailed diagnoses or procedures, partly because it is an administrative document often handled by non-medical staff and because of data-protection concerns, Hölzer said.

Limited options for challenging bills

Questions about hospital bills are common at the Swiss Patients’ Organisation, which advises people affected. Patients who do not understand a bill can contact the hospital’s billing office and request the coding report and discharge report. The health insurers’ association Prio Swiss also says patients can ask their insurer to review the case.

Corrections are made, but they are often handled discreetly and are not always visible to the patients themselves, Prio Swiss said.

The system largely relies on mutual trust, said Anne-Sylvie Dupont, a professor of social security law at the universities of Geneva and Neuchatel. Insurers do not generally check whether a patient actually underwent an operation listed on a bill. Instead, they look for recurring patterns, such as a hospital with a caesarean-section rate far above average.

Dupont said there are few options for patients whose insurer decides to pay a bill despite their concerns. She suggested adding explanations to the back of bill copies or establishing complaints offices, as some hospitals in French-speaking Switzerland have done. However, the administrative costs could outweigh the benefits.

“The system is not transparent. But I do not know of a better solution that I could propose,” Dupont said.