Research: integrated healthcare in Switzerland

3 September 2020. A hospital here, a nursing home there and an out-patient care organi-sation somewhere else – and all of them are busy in their own worlds, without much in the way of coordination. This is what healthcare looks like almost everywhere in Switzerland. Networks are the answer to the great challenges with which our society will be con-fronted with regard to healthcare in the coming years. A study conducted by healthcare management experts of the HSG and of the consultant company KPMG reveals how interlinked integrated healthcare improves quality and efficiency in the health sector. Matthias Mitterlechner addresses performance control in service organisations and networks with a special focus on healthcare. He heads the HealthCare Excellence research programme at the University of St.Gallen. Mitterlechner’s new study reveals the positive impact of regional networks of health service providers. This results in a wide variety of implications for the future con-figuration of healthcare.

Integrated healthcare in a network

The quality of Swiss healthcare is high, waiting times are short, and the population is satisfied with the services. At the same time, the health sector is facing great challenges, including demographic change, a high demand for care services, an increase in chronic illnesses, infectious diseases, the differentiation of expertise, staff shortages, digitalisation, a growing gap between medical and financial capabilities, as well as the safeguard of primary care in rural areas. In order to cope with these challenges, the international research literature suggests that the value creation activities of service providers should be more strongly coordinated along the lines of integrated healthcare in order to promote regional networks linking hospitals, care service providers, general practitioners, specialists and other actors. It was against this background that the Health Ministry of the Canton of the Grisons commissioned KPMG Switzerland together with the HSG to examine the effects of integrated regional healthcare and to draw up organisational recommendations for the establishment of regional healthcare networks.

Comparison of four healthcare regions in the Canton of the Grisons

In order to analyse these issues, the study compares the effects of healthcare practice in two regions with integrated healthcare (Prättigau, Lower Engadine) with those in two regions without integrated healthcare (Upper Engadine, Surselva). Hypotheses were formulated for this comparison which were tested by means of quantitative analyses and whose plausibility was validated by means of qualitative statements. The data analysis was conducted at the aggregated level of “integrated” and “non-integrated” healthcare regions. In sum, the study reveals the following positive effects of integrated regional healthcare:

•    Population-oriented value creation: integrated healthcare regions gear value creation more extensively towards patients and their families. The higher quality results from the structured interface management between the service providers – for instance through regional advice centres and case management for elderly people with complex needs.

•    Cost advantages: operating in a network enables actors to realise operational cost advantages amounting to 20-30% in the ancillary value creation activities such as HR or IT.

•    Needs-based service expansion: in the primary value creation activities, integrated healthcare may first lead to an expansion of services and increasing health expenditure in compulsory health insurance. However, health expenditure in the regions under review remains below the Swiss average, which is more likely to point towards catch-up demand in rural regions rather than towards looming oversupply.

•    Flexible personnel management: personnel management can be conducted in a needs-based and intersectoral manner – with a positive impact on the attractiveness, re-cruitment and operational planning for specialist and management positions.

•    Innovative power: innovative healthcare practices like digital health or disease management are used more frequently in integrated healthcare regions. Staff feel better armed for the future challenges in healthcare.

•    Quality of life and location for the region: innovation has a positive influence on the quality of life and location of the municipalities and creates jobs.

Implications for research and care practice in the health sector

With regard to research, the study reveals the positive impact of integrated regional healthcare in Switzerland, thus corroborating international studies which provide evidence of similar effects of care quality and costs in other countries. In addition, it identifies the positive impact on personnel management, innovative power in healthcare, and re-gional quality of life and location.

With regard to healthcare practice, the study implies that decision-makers in politics, administration and in the service providers will still have to deal with networking issues in healthcare in a much more systematic way. In this respect, the study lists ten specific op-tions for action regarding the development of integration healthcare regions. Networks are the answer to the great challenges with which our society will be confronted with regard to healthcare in the coming years.

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