Schüpfer G, Babst R
Department of Cardiac ICU, University of Gent Hospital, Gent, Belgien.
Praxis (Bern 1994). 2005 Jul 13;94(28-29):1103-11. doi: 10.1024/0369-8394.94.28.1103.
Cost-minimization programs in Switzerland either in the public or the private sector have impact on quality and accessibility of the health care system. Rationalization may induce in fact hidden rationing of care and increases the workload of the health care workers involved. The relation of hospital staffing to inpatient quality of care are important issues. The reduction of funds may place patients at risk, due to lower staffing levels. Patient to nurses ratio have a substantial effect on inpatient mortality and nurse burnout. Research in Switzerland is needed to define the measurement of the nursing case mix on the basis of discharge data and to elucidate the factors influencing the staffing levels of nurses and the mix of nursing personnel in hospitals. Due to reduced funding the ability of hospitals to handle emergency cases may be compromised. The impact on quality and risks of unreflected cost minimization programs in hospitals but also the whole health care system are important and worth of public notice. Possible solutions for a health care reform in Switzerland are outlined and discussed.
瑞士公共部门或私营部门的成本最小化计划会对医疗保健系统的质量和可及性产生影响。事实上，合理化可能会导致隐性的医疗配给，并增加相关医护人员的工作量。医院人员配置与住院护理质量的关系是重要问题。资金减少可能因人员配备水平降低而使患者面临风险。患者与护士的比例对住院患者死亡率和护士倦怠有重大影响。需要在瑞士开展研究，以根据出院数据确定护理病例组合的衡量标准，并阐明影响医院护士人员配备水平和护理人员构成的因素。由于资金减少，医院处理紧急情况的能力可能会受到影响。医院乃至整个医疗保健系统中未加思考的成本最小化计划对质量和风险的影响很重要，值得公众关注。本文概述并讨论了瑞士医疗保健改革的可能解决方案。
