Möckli Nathalie, Wächter Matthias, Moffa Giusi, Simon Michael, Martins Tania, Zúñiga Franziska
Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
Institute for Business and Regional Economics IBR, Lucerne University of Applied Sciences and Art, Lucerne, Switzerland.
Int J Health Plann Manage. 2024 Mar;39(2):477-501. doi: 10.1002/hpm.3744. Epub 2023 Nov 30.
The sustainability and rising costs of the health-care system are of concern. Although health-care reforms impact various areas of care, there is only limited evidence on how regulations affect home-care agencies and health-care delivery.
The primary aim was to explore different financial and regulatory mechanisms and how they drive differences in the organizational structures, processes, and work environment of home-care agencies.
We used data from a national multicenter cross-sectional study of Swiss home care that included a random sample of 88 home-care agencies with a total of 3223 employees. Data was collected in 2021 through agency and personnel questionnaires including geographic characteristics, financial and regulatory mechanisms, service provision, financing, work environment, resources and time allocation, and personnel recruitment. We first conducted a cluster analysis to build agency groups with similar financial and regulatory mechanisms. We then performed Fisher's exact, ANOVA, and Kruskal-Wallis tests to determine group differences in organizational structures, processes, and work environments. Finally, we performed a lasso regression to determine which variables were predictive for the groups.
Four agency groups were built, differing in view of financial and regulatory mechanisms and we found differences in the range and amount of services provided, with regard to employment conditions and cost structures.
The most prominent differences were found between agency groups with versus agency groups without a service obligation. Financial incentives must be well aligned with the goal of achieving and maintaining financially sustainable, accessible, and high-quality home care.
医疗保健系统的可持续性和成本上升令人担忧。尽管医疗保健改革影响到护理的各个领域，但关于法规如何影响家庭护理机构和医疗保健服务提供的证据有限。
主要目的是探索不同的财务和监管机制，以及它们如何导致家庭护理机构在组织结构、流程和工作环境方面存在差异。
我们使用了一项瑞士家庭护理全国多中心横断面研究的数据，该研究随机抽取了88家家庭护理机构，共有3223名员工。2021年通过机构和人员问卷收集数据，包括地理特征、财务和监管机制、服务提供、融资、工作环境、资源和时间分配以及人员招聘。我们首先进行了聚类分析，以建立具有相似财务和监管机制的机构组。然后，我们进行了Fisher精确检验、方差分析和Kruskal-Wallis检验，以确定组织结构、流程和工作环境方面的组间差异。最后，我们进行了套索回归，以确定哪些变量对这些组具有预测性。
构建了四个机构组，在财务和监管机制方面存在差异，我们发现它们在提供的服务范围和数量、就业条件和成本结构方面存在差异。
在有服务义务的机构组和没有服务义务的机构组之间发现了最显著的差异。财务激励措施必须与实现和维持财务可持续、可及且高质量的家庭护理目标保持一致。
