SwissDRG

What is SwissDRG?

SwissDRG is the uniform Swiss tariff structure that hospitals use to bill inpatient treatment in acute care, that is stays for an acute physical illness, an operation, a birth or an accident. The abbreviation stands for Swiss Diagnosis Related Groups. In everyday language, people speak of the case-based flat rate.

The basic idea: the hospital does not bill each individual service, but the case as a whole. Based on the main diagnosis, secondary diagnoses, treatments, age and other characteristics, a hospital stay is assigned to exactly one case group. Each case group has a cost weight, which expresses the average resource use relative to an average case. A cost weight of 1.0 corresponds to a case of average complexity, 0.5 to half of that.

SwissDRG only applies to inpatient treatment. A stay is inpatient if it lasts at least 24 hours, or if you stay for a shorter time but occupy a bed overnight; this is how Art. 3 of the Ordinance on Cost Calculation and Service Recording (VKL) defines it. Outpatient treatment in hospital or in a medical practice is billed under other tariffs. Psychiatry and rehabilitation also have their own structures, TARPSY and ST Reha.

SwissDRG was introduced with the revision of hospital financing. The KVG required the performance-based flat rates to be introduced by 31.12.2011 at the latest. Since 01.01.2012, all hospitals in Switzerland have billed inpatient acute care cases under SwissDRG. SwissDRG AG is responsible for maintaining and developing it further; the tariff partners set it up together with the cantons under Art. 49 para. 2 KVG. The Federal Council approves the structures and any changes to them.

How it works

From diagnosis to case group

After discharge, the hospital codes the diagnoses and treatments according to the official Swiss classifications. Software called a grouper uses these codes to assign the case to a DRG. Each DRG has a code made up of letters and numbers, for example G22D for an appendectomy, that is removal of the appendix, without particular complications.

Cost weight times base rate

The amount for the case is the product of two figures:

• Cost weight: listed in the SwissDRG AG case flat rate catalogue and the same throughout Switzerland. For 2026, billing version SwissDRG 15.0 applies.
• Base rate: the price for a case with a cost weight of 1.0. Hospitals and insurers agree it in a tariff agreement; the cantonal government approves it. It therefore differs from hospital to hospital.

Limits on the length of stay

Each case group has an average length of stay as well as a lower and an upper length-of-stay limit. If a patient stays considerably shorter, the catalogue deducts a reduction for each missing day. If she stays beyond the upper limit, the hospital receives a supplement for each additional day. There are also reductions for transfers between hospitals. This keeps the flat rate fair without each service being billed separately.

Who pays

Two payers share the flat rate: the canton of residence pays at least 55% and basic health insurance pays the rest. The canton sets its share each year at least nine months in advance. The condition is that the hospital is on the Hospital List of your canton of residence or of the canton where it is located. Find out more about the canton’s share under cantonal share.

In basic health insurance, the tiers payant system applies to inpatient treatment: the health insurer pays its share directly to the hospital. The hospital must show the shares of the canton and the insurer separately on the bill. You receive a copy.

Legal basis

• Art. 49 para. 1 KVG: for inpatient treatment, including the stay and care, the contracting parties agree flat rates, as a rule case-based flat rates. They are performance-based and based on structures that are uniform throughout Switzerland.
• Art. 49 para. 2 KVG: the tariff partners, together with the cantons, set up an organisation that develops, refines and maintains the structures. The Federal Council approves the structures. This organisation is SwissDRG AG.
• Art. 49 para. 3 KVG: the flat rates may not include costs of services in the public interest, such as research and university teaching.
• Art. 49 para. 5 KVG: the flat rate covers all the hospital’s claims for services under the KVG.
• Art. 49a para. 1 and 2ter KVG: the canton and the insurer each pay their share of the remuneration; the cantonal share is at least 55% and is set at least nine months before the start of the calendar year.
• Art. 46 para. 4 KVG: tariff agreements, and therefore the base rates too, require the approval of the cantonal government or, for the whole of Switzerland, of the Federal Council.
• Art. 104 KVV: the contribution to the costs of a hospital stay is CHF 15 per day, not including the day of discharge. Children, young adults in education and women who are exempt from the co-payment because of maternity do not pay it.

Example: appendix operation under SwissDRG 15.0

Tim is 27 and has an operation for appendicitis, without complications. The hospital codes the case and the grouper assigns it to DRG G22D “Appendectomy”. The figures come from the SwissDRG 15.0 case flat rate catalogue, billing version 2026, acute hospitals section.

Tim does not pay the flat rate himself. He bears his co-payment in basic health insurance, that is the deductible and retention fee up to the annual maximum, plus the hospital contribution of CHF 15 per day, excluding the day of discharge. For a stay of three nights with discharge on the fourth day, that would be 3 × CHF 15 = CHF 45.

What this means for you

As a patient, you mainly notice SwissDRG on the copy of the bill. It shows the DRG, the shares of the canton and the health insurer, and the days. Check the copy for obvious errors, such as wrong admission and discharge dates.

1. Planned procedures: choose a hospital on the Hospital List of your canton of residence or of the canton where it is located. If the hospital is outside your canton and its flat rate is higher, the canton and health insurer pay at most the tariff of a listed hospital in your canton of residence; you may have to pay the difference if no supplementary insurance covers it.
2. Plan for your co-payment: an inpatient stay almost always uses up your deductible. If a procedure is planned for next year, consider a lower deductible with the deductible calculator.
3. Check your supplementary insurance: semi-private or private insurance covers extra benefits such as free choice of doctor in hospital. The DRG flat rate from basic health insurance is not affected by this.
4. Keep an eye on premiums: hospital costs feed into premiums through the health insurer’s share. In the premium calculator you can compare the premiums of all health insurers, and the profiles under Health insurers show key figures for each insurer.

The entry hospitalisation explains more about how a hospital stay works.

Common mistakes

• Thinking the flat rate is the amount you have to pay. The canton and the health insurer share the flat rate; you only pay your co-payment and the hospital contribution.
• Believing cover ends after the average length of stay. Medically necessary days remain covered; the length-of-stay limits only govern the remuneration between the hospital and the payers.
• Confusing outpatient procedures with SwissDRG. If you go home the same day without occupying a bed overnight, the treatment is usually billed as outpatient treatment, not under SwissDRG.
• Choosing hospitals that are not on the list without asking. Outside the Hospital List, basic health insurance only pays to a limited extent.
• Throwing away the copy of the bill. It is your proof if you have questions about the billing.

How we prepare data on health insurers and premiums is explained under How we calculate.