Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System

Filliettaz, Séverine Schusselé; Berchtold, Peter; Koch, Ursula; Peytremann‐Bridevaux, Isabelle

doi:10.5334/ijic.5668

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…Although the Swiss healthcare system has its own peculiarities, it faces similar challenges as other Western countries, which are calling for more integrated care models. 27 Additionally, our analysis of barriers and facilitators specific to each type of integration has provided data that can be more broadly applied, assisting in anticipating challenges that may arise in various integrated care models. Third, the barriers presented in this report were based on the subjective opinion of respondents, and some respondents may have been more indulgent (or, on the contrary, more critical) in their assessment than others.…”

Section: Professional Integrationmentioning

confidence: 99%

“…Since then, several national research programs and policies have directly or indirectly promoted the development of integrated care in Switzerland. 27 In its health policy strategy for 2020−2030, the Federal Council outlined a comprehensive framework comprising of eight goals and 16 lines of action, including improving the overall quality of healthcare services through strengthening care coordination. It is in alignment with this specific goal that the Federal Office of Public Health commissioned the present study with the intention of both acquiring insights into existing initiatives and identifying healthcare models that may have the potential for further expansion.…”

Section: Introductionmentioning

confidence: 99%

“…These initiatives included disease management programs, initiatives focused on transition or coordination between organizations or healthcare levels, as well as multidisciplinary health centres, physician networks and drug management programs. Since then, several national research programs and policies have directly or indirectly promoted the development of integrated care in Switzerland 27 . In its health policy strategy for 2020−2030, the Federal Council outlined a comprehensive framework comprising of eight goals and 16 lines of action, including improving the overall quality of healthcare services through strengthening care coordination.…”

Section: Introductionmentioning

confidence: 99%

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Integrated care models in Swiss primary care: An embedded multiple case study

Carron

Benedetti

Fringer

et al. 2023

Evaluation Clinical Practice

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Rationale, Aimsand ObjectivesHealthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient‐centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face.MethodWe used an embedded multiple case study design to describe in‐depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within‐case analysis followed by a cross‐case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted.ResultsEight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging.ConclusionThe integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice.

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Section: Professional Integrationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Integrated care models in Swiss primary care: An embedded multiple case study

Carron

Benedetti

Fringer

et al. 2023

Evaluation Clinical Practice

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“…As written by Filliettaz et al (2021), despite the intentions of the federal authorities and the various initiatives that have arisen in recent years in Switzerland, there is still considerable scope for the expansion of integrated care and, in particular, of ICC. In particular, as written by Peytremann-Bridevaux et al (2021), the Swiss system is characterised by the broad scope for creating local initiatives, but at the same time by a certain di culty in spreading these initiatives at national level.…”

Section: Introductionmentioning

confidence: 99%

Caring for the elderly based on an Integrated Community Care approach: the experience of the Canton of Ticino

Roncelli¹

2023

Preprint

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Background The increase in demand for long-term care is associated with the need for cost containment. A transition towards the Integrated Community Care (ICC) approach should lead to cost containment and greater user satisfaction. The Swiss government has repeatedly raised the issue of the integration of care, but Switzerland seems to lag behind in the implementation of this care models. Methods We conducted a series of case studies on the Italian-speaking area of Switzerland with the aim of exploring the reason of network formation. Data was collected using semi-structured interviews. The case studies include six public home care services and twenty nursing homes. The collected data was analysed using ATLAS.ti through content analysis carried out using the Preparation-Exploration-Specification-Interpretation approach. Results The reasons why ICC models are struggling to develop in Switzerland are: i) the caring system is anchored to a broader municipality-based proximity system; ii) the system is historically based on subsidiarity and public-private co-existence; iii) the system is a resource-intensive that is late in perceiving the need to optimise resources; iv) the system based is on a high reliance on formal services; v) the system based on consensus and stability that struggles with the need for rapid intervention. Conclusions The implementation of innovative models of taking care of the elderly is strongly influenced by the institutional context. Policymakers to increase the effectiveness of their interventions are called to eliminate possible institutional barriers.

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“…These types of political tensions have been identified in other studies of integrated care. 2 , 3 In their study of 17 integrated care case studies from 8 European countries, Looman and colleagues identified similar tensions when seeking to implement integrated care. 4 This large comparative case study reveals 10 mechanisms that drive implementation, chief among which was “engaging in alignment work” which helped to overcome the challenge that “macro-level policies are often not supportive of integrating care” (p. 8).…”

mentioning

confidence: 97%

Overcoming Political Fragmentation: The Potential of Meso-Level Mechanisms Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study"

Gray

2022

Int J Health Policy Manag

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Marten’s et al’s paper "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study", offers an in-depth examination of integrated care policy efforts in Belgium. A key finding in this case study was that political fragmentation proved too great an obstacle for integration efforts. In this commentary, I draw on the organizational behaviour and integrated care literatures to suggest how meso-level mechanisms related to sensemaking, distributive leadership, and evaluation could help overcome policy (or macro) level challenges like those experienced in Belgium. The commentary also suggests we need to consider and address both the process and normative challenges in these transformation efforts.

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Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System

Cited by 9 publications

References 18 publications

Integrated care models in Swiss primary care: An embedded multiple case study

Integrated care models in Swiss primary care: An embedded multiple case study

Caring for the elderly based on an Integrated Community Care approach: the experience of the Canton of Ticino

Overcoming Political Fragmentation: The Potential of Meso-Level Mechanisms Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study"

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