The Swiss healthcare system is highly fragmented, with lots of different responsibilities and competences for care, financing, and rules of payment. Competence for care is distributed to a manifold of noncoordinated care providers: physicians in their surgeries, state and private hospitals, home healthcare services, rehabilitation and health resort institutions, old people’s or nursing homes. There are gaps between these sectors, lack of information flow, duplicates of technical equipment, and in diagnosis, breaks in therapies, all resulting in suboptimal care and excessive costs.
A pilot study aimed to find out if a model of highly integrated care for elderly patients leads to better results in quality and costs. A ‘vertical integration’ of all care providers and sectors, as well as a joint management, is meant to assure the continuity of care. For a test phase the sectors involved in the region of intervention will be reorganised. The aim is to find out methodological and organisational possibilities and restrictions, consequences for the Canton of Bern in law, planning and financing, and come to results for future mandating of the hospitals and for the cantonal Service Provision Planning schemes to come.
The pilot study is based on the Service Provision Planning 2007-2010 of the Canton of Bern and is embedded in the cantonal Service Provision Planning schemes to come. With demographic change and an ageing population, this Canton meets a rising number of degenerative and/ or chronic diseases. These elderly patients need long-term therapy, involving a lot of care providers. Coordinating and integrating the care for geriatric patients in a highly fragmented healthcare system is quite a challenge, even more so under conditions of current budgetary constraints. With integrated care they hope to achieve delivery of much higher levels of service standards, and a better quality of care thanks to a better information flow. This will probably not lower costs, but instead lead to a much lower level of cost increase, as duplication in technical equipment and in diagnosis and breaks in therapies will be avoided, which normally result in additional costs. Results will be integrated into the future mandating of hospitals.
The pilot study is meant to start in the middle of 2011, for a two-year test phase. Its objectives are to compare costs and benefits of integrated care for geriatric patients in a setting of an acute hospital with conventional geriatric care. It is a non-randomised study without matching of patients, but similar structures in care, with a six month follow up. The setting is as follows: two Regional Hospital Centres and approximately 800 patients accepted for admission to the study. Interventions will be: An integrated team from the institutions, the professions and the informal sector caring for the patient and; A personal coach to organise patients’ pathways within and after leaving the hospital. As main outcome measures they shall have patient’s functional status, readmission to hospital, type, frequency and costs of services provided, users’ satisfaction, and demand for integrated care. In addition, findings concerning chances and restrictions in promoting integrated care in the Swiss healthcare system are expected.
|Award category:||smart public service delivery|
|Sector:||Public health and social welfare/affairs|
|Type of activity:|
|Keywords:||Integrated care, networks, geriatric patients, quality of health care, costs of health care|
|Short English description:||Its objectives are to compare costs and benefits of integrated care for geriatric patients in a setting of an acute hospital with conventional geriatric care. It is a non-randomised study without matching of patients, but similar structures in care, with a six month follow up.|
|Organisation:||Department of Health and Social Welfare of the Canton of Bern, Hospital Office|
|Level of government:||regional level|
|Size of organisation:||>100|
|Number of people involved:||6-10|
|EU membership:||other European country|