Institute of Social and Preventive Medicine (Lausanne University Hospital & University of Lausanne), Route de la Corniche 10, CH-1010 Lausanne, Switzerland; Forum Managed Care (FMC), Zugerstrasse 193, CH-6314 Neuägeri, Switzerland.
Forum Managed Care (FMC), Zugerstrasse 193, CH-6314 Neuägeri, Switzerland.
Health Policy. 2018 Jun;122(6):568-576. doi: 10.1016/j.healthpol.2018.03.006. Epub 2018 Mar 17.
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.
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.
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.
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.
由于医疗服务的碎片化，卫生系统面临压力，因此提倡整合医疗服务。与欧洲和其他地区众多现有的整合医疗服务举措相比，瑞士似乎落后了。
该调查的目的是全面概述瑞士的整合医疗服务举措。要被纳入，这些举措需要满足以下四个标准：有某种形式的规范化、考虑到>2 个不同类别的医疗保健专业人员、整合>2 个医疗保健层级、正在进行中。我们系统地联系了联邦、州和地方各级的主要卫生系统组织。在 2015 年至 2016 年期间，我们确定了 172 项整合医疗服务举措，并向它们发送了一份调查问卷。我们进行了描述性分析。
瑞士的整合医疗服务举措频繁且不断增加。随着时间的推移，这些举措的实施情况、它们在语言区的分布情况、整合的医疗保健层级数量以及涉及的专业人员数量因举措的类型而异。
尽管瑞士的联邦结构和医疗保健组织形式以及最近才鼓励发展整合医疗服务，但这些举措仍然频繁且多样化。利益相关者应支持现有的举措并促进其发展。他们还应推广创新途径，为整合医疗服务试验替代支付模式，促进以人为本和激励跨专业模式。这将需要系统思维和医疗保健系统所有参与者的贡献。
