Integrated care in Switzerland: Results from the first nationwide survey
Abstract Introduction Due to fragmentation of care delivery, health systems are under pressure and integrated care is advocated for. Compared to the numerous existing integrated care initiatives in Europe and elsewhere, Switzerland seems to lag behind. Methods The objective of the survey was to produce a comprehensive overview of integrated care initiatives in Switzerland. To be included, initiatives needed to meet four criteria: present some type of formalization, consider >2 different groups of healthcare professionals, integrate >2 healthcare levels, be ongoing. We systematically contacted major health system organizations at federal, cantonal and local level. Between 2015 and 2016, we identified 172 integrated care initiatives and sent them a questionnaire. We performed descriptive analyses. Results Integrated care initiatives in Switzerland are frequent and increasing. The implementation of initiatives over time, their distribution between linguistic areas, the number of healthcare levels integrated, and the number of professionals involved vary according to the type of initiatives. Discussion Despite Switzerland's federalist structure and organization of healthcare, and only recent incentives to develop integrated care, initiatives are frequent and diverse. Stakeholders should support existing initiatives and facilitate their development. They should also promote innovative avenues, experiment alternative payment models for integrated care, foster people-centeredness and incentivize interprofessional models. This will require systems thinking and contributions from all actors of the healthcare system. Highlights Despite only recent incentives, integrated care initiatives are frequent in Switzerland. Characteristics of these initiatives vary over time and across linguistic areas. Diversity of local integrated care innovations must be further enabled. A systemic approach to integrated care is required (macro, meso and micro levels). Alternative payment models for integrated care are needed.
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