Integrated care: Why not faster, better and cheaper?

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Integrated care has long been called for in the Swiss healthcare system and yet many corresponding projects are stagnating. Why is that? What could be done in concrete terms? Will everything be better thanks to EFAS?

Integrated healthcare refers to the deliberate coordination of healthcare services in which various service providers work together to ensure patient-centered, needs-based and seamless care. But what does this mean in concrete terms? In coordinated or integrated care, general practitioners, specialists, therapists, hospitals, pharmacies, retirement and care centers - ultimately all ’healthcare professionals’ - see themselves as part of a larger whole and pull together for the benefit of the population or patients.

There is no lack of good will on the part of individuals, but such holistic seamlessness is rarely guaranteed in Switzerland, even in 2024. Structured, binding cooperation and seamless communication (including electronic data exchange!) serve to ensure the quality of treatment and patient care across the entire supply chain. Integrated care should help to avoid duplication and overprovision and thus also save costs. Efficiency is not only an important factor in healthcare from a cost perspective, but also increases the quality of care. Last but not least, due to the already noticeable shortage of specialists, we must become more efficient in order to guarantee adequate healthcare in Switzerland in the future.

Why do we still not have coordinated care in Switzerland today? Of course, service providers exchange information about their patients, but they often do so rather unsystematically and rarely electronically. The various financing mechanisms do not help with their incentives: individual service tariffs, i.e. the remuneration of individual services, are more likely to encourage patients to repeat examinations than to rely on the assessment of a colleague from another company or another discipline. We all know of enough examples where there was no communication or coordination at all between service providers - or where better communication and coordination would have been possible.

Will the uniform financing of outpatient and inpatient services (EFAS), which will probably soon be introduced in Switzerland, solve the problem? Unfortunately no, or at least not without additional measures. The reduction of disincentives in the decision as to whether treatment is provided on an inpatient or outpatient basis will at least partially be eliminated, which is positive. However, comprehensive integrated care requires far more than just a standardized financing system. Here are a few keywords on the areas in which changes in attitude and concrete measures will be necessary:

  • Interprofessional collaboration: implementation of coordinated consultation and treatment/nursing practice, knowledge of the skills and approaches of other professional groups, trust in other disciplines and professional groups
  • Patient-centeredness and health literacy: focus more consistently on patients’ needs, include and promote patients’ skills and resources
  • Improving the data basis and use of data: data-supported patient pathways, breaking down data silos, linking cost data with performance data, systematic processing and use of data in the treatment process and for research
  • Professionalize policy, management and care based on evidence: Develop and implement clear strategies, goals and processes at a political, operational and professional level; end political (including professional) trench warfare in favor of the population and patients
  • Further development of tariff structures and adjustment of financing mechanisms to compensate for coordination, extended services, data use and quality
  • Digitalization and digital transformation: knowledge management, planning, coordination, communication
  • Inclusion of social counseling and support
  • Strengthening prevention and health promotion

The fact that these issues are also topical in everyday politics is shown, for example, by the debate in Central Switzerland about the reorganization of Wolhusen Hospital. This is because it is often more a discussion about individual specialties than a - in our view more meaningful - debate with all stakeholders about what successful, coordinated care in the Wolhusen region would look like.

Another example is the struggle in many smaller communities to keep GP practices in the village. Many GPs can no longer find a successor and practices are being closed. In some cases, highly qualified nursing staff (advanced practice nurses) can take over certain services and proactive, innovative municipalities or regions are organizing a center for coordinated care with various service providers. There is great potential here for a successful public-private partnership in municipalities and regions.

A team from the Lucerne University of Applied Sciences and Arts is currently planning an implementation-oriented research project to promote integrated care in Central Switzerland and will be happy to advise you on these topics.