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CSS Insurance

Questions & Answers

Are you looking for further information regarding the published data, the search results or the ranking? Most common questions will be covered here.

Information

What are case numbers?

Case numbers show how many inpatient operations and treatments were performed in which hospital during a particular year. In principle it can be assumed that a high case number correlates with more experience and expertise and thus indicates a higher quality of treatment. However, when comparing hospitals it is important to consider the invariable effect of size on the case number (e.g. comparing a university hospital with a regional hospital). In addition, the treating physicians at a large hospital may vary, while in a small hospital the same doctor is likely to perform certain treatments or operations regularly.

Case numbers are analysed based on the information provided by the SwissDRG (Swiss Diagnosis Related Groups), which refers to case groups. They form the basis of the Swiss hospitals' flat-rate-per-case system and are linked to diagnoses. It is not always possible to assign all DRG codes clearly to a diagnosis. Therefore, the case numbers in Qualicheck may differ in part from those recorded by the hospitals themselves.

QualiCheck also offers summaries of similar and related operations and treatments – where doing so makes sense – so as to provide the general public with information that is meaningful in terms of scope and detail.

How can I interpret the case numbers for individual locations and hospital groups?

As a rule, each hospital has its own paying agent register number (ZSR no.). Case numbers are collected on this basis. If a group of hospitals work together as a network, it may be that:

  • all the hospitals have the same ZSR no. or
  • each individual hospital has its own ZSR no. or
  • some individual hospitals in the network have their own ZSR no.
     

When it comes to interpreting case numbers, this means:

  • case numbers are reported for the network as a whole. Therefore, a high case number for the entire network cannot be applied to the individual hospital.
  • case numbers are disclosed for the individual hospitals / locations.
  • case numbers are disclosed both for individual hospitals (with their own ZSR no.) and for the network (one ZSR no. for several locations).

Which quality indicators are shown and which ones not?

The published patient satisfaction indicators from CSS and ANQ, as well as the CSS assessments, case numbers, wound infection rates, hospital re-admissions, and information on pressure sores, differ in terms of their importance and interpretation. CSS and ANQ patient satisfaction figures reflect subjective findings on the quality of the treatment and results. Case numbers, wound infection rates, hospital re-admissions and pressure sores, on the other hand, provide objective measures of quality. No information is provided on the quality of processes and organisational aspects, e.g. hospital facilities, training and development of staff, documentation of medical histories, emergency and palliative care concepts, etc., as well as on disciplinary and interdisciplinary processes and circumstances. Instead, these are examined by our experienced specialists on site as part of the CSS Insurance quality assessments, and reflected under the hygiene, care and quality and risk management categories.

When is the information updated?

All data – i.e. CSS’s own data and data that is publicly available – is generally updated as quickly as possible. If no figures are available for the current period, the previous year’s figures are stated. In other words, published results may refer to different years.

Number of cases per DRG – 2016
Patient satisfaction CSS – 2015, 2016, 2017, 2018
Patient satisfaction ANQ – 2018
Pressure sores – 2018
Wound infection rates – 2016, 2017
Hospital re-admissions – 2015, 2016
Additional quality information – 2016, 2017, 2018

Starting in 2019, the CSS patient satisfaction survey will be conducted on an annual basis and over a standard period of 6 months. If no information is available for the hospital you have searched for, it is either because the hospital was not included in the survey or the response rates were too low. In the latter case, we prefer not to publish the data as the results do not provide enough information value.

Where does the information come from?

The published information on quality issues at Swiss acute hospitals comes from public sources (e.g. ANQ) and CSS's own surveys. It was subsequently adjusted and processed to make it easier to understand (e.g. by rounding up figures to two decimal points, calculating the average of all questions in a particular category, etc.).

Public sources include

  • ANQ data: wound infections, pressure sores in categories 1–4, patient satisfaction surveys and hospital re-admissions
  • the Federal Office of Public Health (FOPH): Case numbers
     

The data collected by CSS itself includes

What is an acute hospital?

An acute hospital is a general medical centre in the classical sense that provides services relating to examinations, treatment and patient care. Each acute hospital operates under a cantonal service mandate which authorises it to carry out the relevant surgeries and treatments.

What is the ANQ?

ANQ stands for Swiss National Association for Quality Development in Hospitals and Clinics and is a national association for quality development in hospitals and clinics.

What is the BAG?

BAG (Federal Office of Public Health) is part of the Swiss Federal Department of the Interior and, together with the cantons, is responsible for public health in Switzerland and for developing the national health policy.

What is ValueQuest?

ValueQuest is a scientifically-based marketing research company that has been conducting patient satisfaction surveys for CSS for many years.

Search results / ranking

How are the search results sorted and displayed?

The ranking of the displayed hospitals is based on the case numbers. For example, if you are looking for a clinical picture without entering the place, canton or hospital in the text box, you will see the six hospitals (in declining order) with the highest case numbers from anywhere in Switzerland. Unless you enter a clinical picture in the text box, the case numbers shown in the search results field always refer to the whole hospital. If the case numbers of the displayed hospitals are the same, the ranking takes place alphabetically. In the compare hospitals view, you can also sort the values of the quality indicators in ascending and descending order.

Why does no information on quality appear for the hospital I selected? (Message "No information")

Possible reasons include:

  • The hospital has not conducted a survey,
  • The information is still being processed and is not yet available,
  • The ANQ has dispensed the hospital and it is thus exempt from the current measurement,
    The quality of the information is so low that it cannot be displayed,
  • The response rate is so low that the information cannot be displayed,
  • The hospital has explicitly asked not to publish the information, or refuses to do so in principle,
  • CSS has not yet conducted a patient satisfaction survey at this hospital.

Why does the hospital I'm looking for have a different name?

The current name of the hospital is used. Differences may also arise because the hospital has become part of a group or changed its name. In case of doubt, we recommend that you search by location.

Why does the hospital I'm looking for not appear at all?

The hospital is either not an acute hospital (but a rehabilitation clinic, for example) or it has closed. Only quality indicators of hospitals in operation are shown.

Why are only these and not other hospitals in the area shown?

You start your search by entering the clinical picture and the location. However, if the location does not have a hospital nearby, the search is expanded until at least one hospital is found for which case numbers exist for the clinical picture you are querying.

Why is the highest positive decubitus rate shown in red, thus indicating a bad result?

Values of less than zero indicate that pressure sores occur less frequently than average for all hospitals. Values of more than zero indicate that pressure sores occur more frequently than average for all hospitals. "- 2" is therefore better than "-1", "-1" is better than "1", and "0" is average.

How does the mobile QualiCheck work?

The mobile version gives you all the functions of the desktop version, except for the map and the mannequins.

Quality indicators

Patient satisfaction surveys

What is the background to CSS's own survey, and which key figures and information from the patient satisfaction survey are shown?

CSS has been surveying its insured persons since 2014 about their general satisfaction after an acute hospital stay. Insured persons aged 18 and over who have spent at least one night in hospital during the preceding three months are included in the survey. An insured person will be asked about their hospital or rehabilitation experience only once during any particular year.

When interpreting these results, please note that they are not risk adjusted. Adjusting quality indicators to take account of risk means that patient-specific factors such as age, length of stay or prior illnesses, as well as differences in the distribution of these risks (patient mix) between hospitals are also factored into the calculation. Therefore, a lower level of patient satisfaction need not necessarily translate into a poorer quality of result.

The questionnaire contains 21 main questions, broken down into various categories (e.g. “Administrative procedures”, “Doctors” etc.). A single category may contain several questions whose results are reported as mean values. You will find details of the various questions and categories in the patient satisfaction questionnaire (not available in English).

As incomplete questionnaires (e.g. only four of the seven questions in the "Doctors" category answered) are included in the analysis, the number of responses indicated may vary. The scale of 1-6 (same as is used in Swiss schools) has 1 as the poorest rating ("not at all") and 6 as the best rating ("fully").

On the whole, we regularly achieve good response rates to our surveys. However, please note that not all hospitals receive a large number of ratings. This is because they do not all treat the same number of persons insured with CSS who are subsequently surveyed.

Note: persons insured with CSS who have stayed at an inpatient rehabilitation facility have also been surveyed since 2016. These results are not yet published in QualiCheck.

What is the background of the ANQ survey, and what information is shown?

From 2020, the ANQ patient satisfaction survey will be conducted every second spring. The target group is made up of patients aged 18 and over who have spent at least one night in hospital and were discharged in September.

The survey consists of six questions, with a range of possible answers. For the first five questions, the respondent must choose between 1 (most negative) and 5 (most positive); for the sixth question the respondent must choose between 1 (too short) and 3 (too long). Based on these response options, QualiCheck shows only the average of the first five questions as the result. The average comprises all the questions, weighted equally, for the location in question.

The questions are:

  • How do you rate the quality of the treatment you received from the doctors and nurses
  • Were you given the possibility to ask questions?
  • Did you receive satisfactory answers to your questions?
  • Did you receive satisfactory explanations about the purpose of the medication you were supposed to take at home?
  • How well was your discharge organised?
  • What do you think about the length of your hospital stay?


As the ANQ aims to record and compare measurements from satisfaction surveys conducted throughout the country, all the results are risk adjusted. In relation to acute care, this risk adjustment takes account of the person's age, gender and location after discharge, among other factors. Hospitals with fewer than 50 evaluable questionnaires are not included in the measurements.

CSS assessments

What is the background of the CSS assessments, and what benefits do they offer service providers and patients?

As Switzerland's largest health insurer, CSS aims to provide clients and patients with clear quality data and greater transparency about quality assurance in hospitals, rehabilitation clinics, and psychiatric treatment facilities.

CSS experts evaluate a range of quality criteria from the client perspective, and collate them into an overall list. These criteria are examined and scored in on-site assessments at the hospitals concerned. They offer added value to clients and hospitals alike. We believe that our assessments provide clients and patients with a 360-degree view of the action that the clinic has taken to ensure – and to continue enhancing – the quality of its care. Furthermore, they give hospitals, rehabilitation clinics and psychiatric treatment facilities an opportunity to show how they are committed to serving their patients on a day-to-day basis.

Further public metrics

What is a pressure sore?

A pressure sore (decubitus) is a skin injury that also affects the tissue underneath. Inadequate or incorrect care (e.g. if the patient is incorrectly positioned or spends a long time lying on one side) may be among the possible causes. That’s why the frequency and type of pressure sores also serves an indicator of the quality of care. The published values for categories 1-4 (i.e. all types of pressure sores, including lesser (1) and more severe cases (4)) relate to the hospital as a whole and not to a specific clinical picture. This indicator is particularly relevant for patients facing an extended stay in hospital and/or patients who are at greater risk of developing a pressure sore.

How are pressure sores measured and how are the results interpreted?

The prevalence measurement is conducted on one specific day each year. The results are disclosed as a risk-adjusted residual value; in other words, patient-specific factors such as age, length of stay etc. are also factored into the calculation. Values of less than zero indicate that pressure sores occur less frequently than average for all hospitals. Values of more than zero indicate that pressure sores occur more frequently than average for all hospitals: “-2” is therefore better than “-1” and “-1” is better than “1”. “0” is average. Please note that the measurement date may lead to distortions because not all patient groups can be taken into account on a single day.

To what does ‘hospital re-admission’ refer to?

No patient wants to be re-admitted to hospital. It means having to return after being discharged because of a problem that was known during the original stay. It is not the desired outcome for anyone concerned, and may have a number of reasons. These are not always the fault of the hospital, however, neither are they always avoidable. That is why a hospital's re-admission ratio will never be zero. The normal figure is 1.0. If patients are being re-admitted frequently, the hospital must investigate the cause before negative conclusions are made about the quality of preparations for discharge.

Re-admission is potentially avoidable if it:

  • is not foreseeable when the patient was last discharged
  • occurs within 30 days of discharge
  • is caused by at least one condition that was known upon discharge


The calculation covers all inpatients, including children. It does not include:

  • deceased patients or those who transferred to another hospital 
  • healthy newborns 
  • day-case surgery patients 
  • patients whose place of residence is abroad


The primary aim of the indicator (ratio) is to check the following points:

  • was the discharge prepared well?
  • were the diagnoses clear?
  • did the patient receive appropriate treatment upon their discharge?
  • was any post-discharge outpatient care planned?
  • did the attending doctor brief the family or, where necessary, the health visitor service?

What is the wound infection rate?

A postoperative wound infection refers to a condition that sets in and affects the treated body part or organ within one month, or 12 months in the case of defined types of surgery, after the operation. The displayed risk-adjusted wound infection rate refers to the entire hospital and includes all infection types, i.e. both superficial ones and those that occur deep within organs or cavities. Adjusting risk aspects to the quality indicators means that patient-related factors such as age, length of stay, prior illnesses, as well as differences in the distribution of these risks (patient mix) among the hospitals is also factored into the calculation.

All hospitals affiliated with the ANQ are obliged to participate in the measurement. Out of a total of ten index operations, two are voluntary; out of the remaining eight, three must be selected and included in the measurement. All hospitals whose services include surgery of the large intestine are obliged to carry out this wound infection measurement.

QualiCheck gives you the wound infection rates in the detailed view of the hospital. To enable you to compare hospitals in terms of a selected clinical picture (e.g. digestive tract), we chose to show what we believe is the most frequently measured or occurring wound infection rate (the large intestine in this case). In addition, the available wound infection rates are shown in the blue box once you have selected a clinical picture. The detailed view of the hospital provides an overview of all the measured and displayed wound infection rates.

What is medical rehabilitation?

Medical rehabilitation is designed to improve a patient's health following surgery, a serious illness, or an accident. Doctors, nursing staff and therapists (such as physiotherapists and occupational therapists, as well as speech therapists) work together closely to achieve this. While undergoing rehab, patients receive a targeted programme of treatment to allow them to return to an independent life as quickly as possible. In addition to medical care, patients (and sometimes also their families) receive advice and support from social services. The aim is for the individuals concerned to need minimum support with their daily lives.

Rehab may be offered on an outpatient, partial inpatient (in day care hospitals) or inpatient (at a rehabilitation clinic) basis.