“Integrated care” panacea: American model to heal the Swiss healthcare system

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More and more treatments, more expensive medicines, sky-high healthcare premiums: there seems to be no remedy for the rising costs in the healthcare system. Meanwhile, Parliament is pursuing a plaster-and-paste policy in the battle for suitable recipes. The Council of States pulled its teeth last week with its counter-proposal of the SP premium deduction initiative. The same thing happened with the cost containment initiative in the middle. How to break this Gordian knot is one of the greatest mysteries in federal Bern.

One step further is in the Bernese Jura, at the Moutier Hospital. There, the Swiss Medical Network group wants to prove next year that an efficient, high-quality and cheaper healthcare system is possible. To this end, the service providers in the Jura region have united in a network, the Réseau de l’Arc. From 1 January 2024, basic medical care, hospital services or elderly care must be provided from a single source, coordinated by a single organization. “That changes everything,” says Alexandre Omont (44), the director of the Réseau de l’Arc.

The current system suffers from perverse incentives, says Omont. For example, for financial reasons, examinations that a GP had previously carried out would be repeated in the hospital. The information flow between the service providers is stagnating because different systems are in use and in some places even fax machines are still used for data transmission. The focus is often not on the patient, but on profit.

Prevention instead of response

Prevention is an important pillar in the new system. “If you are healthy, it costs nothing,” says director Alexandre Omont. A survey in the Jurassic region recently showed that only 40 percent of women for whom a test for early detection of breast cancer was indicated actually had a screening. At the Réseau de l’Arc, trained staff will closely supervise members and, if necessary, inform them by telephone about important upcoming exams.

The canton of Bern and the health insurance company Visana are also on board the Réseau de l’Arc. Their new insurance is called “Viva” and is currently under investigation by the Federal Office of Public Health (BAG). The product works like basic insurance in an alternative model. This means that everyone who opts for chain care does so for a year. If someone is not satisfied with the service afterwards, they simply switch providers, as before. In terms of price, the insurance model must be able to keep up with the five cheapest offers.

Someone who is already convinced of the new approach is Alain Kenfak (41), doctor at the Moutier Hospital and medical director of the network. He says: “Today we don’t know the patients. If they are healthy, we don’t have access to them.” That makes prevention difficult. At the Réseau de l’Arc, members not only receive a discounted subscription to a fitness center. Because you know the people better, you can recommend individual prevention programs. Anyone who has bad eating habits is invited to the clinic for coaching and experts are available on site for smoking cessation treatments.

If an organization arranges appointments, coordination and support, the doctors have more time for their treatments. Today, administrative tasks take up 40 percent of work time, says Kenfak. “It makes a lot more sense to delegate that to people who are very familiar with it.”

Exactly the US

Antoine Hubert (56), the board representative of Swiss Medical Network, found inspiration for the Réseau de l’Arc in a country not exactly known for its functioning health system: the US. Kaiser Permanente has been demonstrating there for decades that integrated care pays off for patient and service provider. The organization has 12.6 million members serving 39 hospitals. On average, the company registers 150,000 hospital admissions per year. In comparison, 276 hospitals are available to Switzerland’s 8.7 million people, and almost 1.4 million hospital admissions are recorded each year – nearly ten times that number. Studies have shown that those insured with Kaiser Permanente in the US live an average of six years longer than the rest of the population. Hubert: “It is our responsibility as service providers and insurers to find an alternative to the current system, which is doomed to fail.”

The federal government has also recognized that integrated care can offer solutions in the fight against rising healthcare costs. In its cost containment package 2, which the parliamentary health committees are currently discussing, a coordinated care network is explicitly envisaged as a new service provider. In its message of September 2022, the Federal Council writes: “In a network for coordinated care, health professionals from different professions come together under medical supervision to provide medical care that meets the needs of the patient from a single source.”

A broad alliance of health professionals opposes these plans. In an editorial in the “Schweizerische Ärztezeitung” FMH president Yvonne Gilli (66) wrote: “This construction is not going to work. This horse is dead and unfit to ride.” It remains unclear why policyholders avoiding alternative insurance models should seek out this new service provider, which does not even offer premium discounts. The criticism does not refer to initiatives such as the Réseau de l’Arc, Gilli confirms the Sunday view. “On the contrary, we are open to such models.” However, the FMH opposes “microregulation” by the federal government. The example of Jura shows that integrated care models are created even without new laws. “If the government prescribes too rigid structures, innovation is no longer possible.”

Skeptical politicians

As for the Réseau de l’Arc, Gilli warns that it is an illusion to believe that an American system can be imposed on local conditions, which are historically and culturally determined. Our country is small, the different regions need systems that take into account their particularities, says the doctor and former Greenlandic councillor.

Health politician Martina Bircher (39) sees no need for more state regulation. The SVP National Councilor says: “Reality has caught up with Health Minister Alain Berset.” Models such as the Réseau de l’Arc illustrate this. With new regulations, the system will be deprived of air to develop. “The federal plans may be well-intentioned, but in the end they do more harm than good.”

In the Jura, people are convinced that the pioneering work is worthwhile – and that it will triumph throughout Switzerland. Antoine Hubert: “Fully integrated systems provide better quality of care and more efficiency – and are therefore cheaper.”

Source:Blick