Switzerland’s healthcare system, known for its quality and accessibility, faces pressing challenges, threatening its sustainability. As per the Federal Council’s Health Policy Strategy 2020-2030 (BAG, 2019), these encompass rising costs, the prevalence of non-communicable diseases, or acute care emphasis over prevention. Moreover, Switzerland confronts an array of complex issues including a deficit of highly-skilled workforce, unresolved transparency concerns, pervasive social inequalities, and a lagging rate of digitization in the healthcare industry. Finally, increasing health insurance premiums pose troubles for households, with healthcare access often dependent on socioeconomic status.
Central to the challenges the Swiss system is facing is our prevailing fee-for-service model, where healthcare professionals are paid based on the number of procedures performed. Though not without merit, this system has unintentionally fostered a culture of counter-productive incentives. Consequently, the primary concern often drifts from ensuring patient health and well-being to accruing billable treatments and processes, many of which may have a negligible impact on patient recuperation or enhanced health results (PwC, 2020).
Among the potential solutions that can help overcome our current challenges and achieve the goals of the Health2030 (see annex) strategy is Value-Based Healthcare (VBHC). By shifting the focus from quantity to quality, VBHC presents a viable alternative to the traditional healthcare model and holds the promise of addressing many of the issues the Swiss healthcare system is currently facing. But what does VBHC entail, and how can it be implemented in the Swiss context? These questions form the focus of our discussion in the following sections.
The Solution: Value-Based Healthcare (VBHC)
Value-Based Healthcare (VBHC)(VitalAire, 2023) has emerged as a promising solution to the challenges our healthcare systems are facing. The premise of VBHC is simple yet transformative: measure the success and effectiveness of the healthcare system not by the quantity or impact of individual procedures but by the health benefits to the patients. This patient-centric model could drastically alter our healthcare approach, advocating for effective procedures that yield the greatest health benefits.
VBHC represents a paradigm shift from volume to value, quantity to quality, and intervention to prevention and wellness. In essence, it is a proactive approach to healthcare, as opposed to the reactive model we often see today.
A further aspect of VBHC is its emphasis on ambulatory care. This approach seeks to treat patients outside the traditional hospital environment wherever possible, opting for clinics or home-based care. Ambulatory care is typically less expensive than inpatient care, reducing the financial burden on the healthcare system. Beyond cost-efficiency, it also brings care closer to the patient’s daily environment, promoting comfort and ease during the healing process. This alignment with the patient’s needs and preferences underscores VBHC’s commitment to putting patients at the center of healthcare delivery.
The Role of VBHC in Patient Care
The adoption of VBHC has profound implications for patient care. First, it places patients at the heart of the healthcare system. Patients become more than just passive recipients of care; they become active participants in their treatment process. They are entrusted with more responsibility for their recovery process, empowering them to play a vital role in their health journey.
This shift also aligns well with the rising demand for more patient involvement in care. According to a study titled “The Future of the Care Landscape in Switzerland” by PricewaterhouseCoopers, patients today desire to play a more active role in their healthcare decisions .
VBHC also encourages comprehensive quality measurement along the entire patient pathway. This process requires the collection and analysis of a wide array of quality indicators over an extended period. Furthermore, digital technologies pave the way for personalized treatments. Tools such as telemonitoring facilitate the process of data collection and enhance the patient’s healthcare journey. Consequently, VBHC enables the integration of long-term trends associated with previous treatments into the planning of future interventions. This long-term view is critical for chronic disease management and helps prevent unnecessary procedures and costs. Nevertheless, it presents new challenges, especially regarding the creation and measurement of these appropriate Key Performance/quality Indicators (KPIs) or data privacy issues.
Potential Obstacles and Mitigation Strategies on the Road to VBHC
Adopting a new paradigm is never without challenges, and VBHC is no exception. For one, transitioning from a fee-for-service model to VBHC is no small undertaking. The healthcare system is deeply entrenched in the current payment structure, necessitating considerable effort and time for a successful transition.
One of the substantial barriers to VBHC implementation lies in the area of KPIs’ measurement and data management. Indeed, implementing VBHC requires collecting, analyzing, and managing an extensive range of patient data. Handling this data securely and ethically is of paramount importance. Yet, such a database is critical to track patients’ health outcomes over time and determine the effectiveness of different treatments. Healthcare institutions must invest in secure and robust data infrastructure to make this possible. This is already a problem we see with the Electronic Patient Record (EPR)(Patientrecord, 2023). While the EPR has found acceptance among legislators and is primed for effective utilization, in practical terms, it encounters significant pushback from key stakeholders, including patients and medical professionals.
Moreover, resistance to change could also pose a significant obstacle. Many in the healthcare industry, from administrators to doctors, have been operating under the fee-for-service model for their entire careers. Convincing them of the need for change will require substantial evidence of the benefits of VBHC.
To mitigate these obstacles, a multi-pronged approach is necessary. This includes educating all stakeholders about the benefits of VBHC for our whole system and for the patients, investing in robust data systems, and providing support during the transition period. Policymakers and healthcare leaders will need to present a strong case demonstrating how VBHC can enhance patient outcomes, reduce unnecessary spending, and ensure the sustainability of the healthcare system.
Addressing our healthcare challenges
Several measures could potentially revitalize the Swiss healthcare system by addressing inefficiencies and shifting towards a more patient-centered care paradigm. A transition to uniform financing for both stationary and ambulatory patient services could minimize overheads, boost transparency, and foster a comprehensive view of the total costs along the patient pathway. This could be made possible by consolidating the distinct financing of ambulatory and stationary services into a common system, known as Uniform Financing (EFAS), further facilitated by directing a constant financing portion from the cantons into a shared institution. Presently, the financial burden of stationary medical treatment costs in Switzerland is shared, with the cantons shouldering 55 percent and health insurers covering the remaining 45 percent. However, when it comes to ambulatory expenses, health insurers bear the full 100 percent cost, which is then reflected in the premiums paid by their insured individuals (FMH, n.d).
Furthermore, a new payment system in line with the Value-Based Healthcare (VBHC) approach, where payments to providers reflect the measurable value added for patients, could also help reorient the health system towards more patient-centered care. Lastly, implementing comprehensive quality measurement throughout the entire patient pathway would enable the evaluation of both immediate and long-term results, providing greater transparency over the quality and cost of services.
Is VBHC really the solution?
Implementing Value-Based Healthcare could indeed be pivotal in tackling the challenges besetting the Swiss healthcare system. By focusing on long-term health outcomes and patient-centric care, VBHC aims to improve patient outcomes, especially those with chronic conditions. Furthermore, by linking costs to patient outcomes, VBHC promotes more efficient use of resources and seeks to eliminate unnecessary spending. Therefore, VBHC not only aims to maintain the high-quality care Switzerland is renowned for but also ensures the sustainability of our healthcare system in light of the current challenges.
In conclusion, Value-Based Healthcare offers a strategic opportunity to reorient the Swiss healthcare system to effectively respond to current challenges. However, this shift necessitates a collective alignment and harmonization among all key players within the healthcare landscape – policymakers, healthcare providers, insurance companies, and patients alike. Central to this alignment is the definition of performance indicators that resonate with all stakeholders and a shared commitment to this innovative approach. In embracing VBHC, we not only respond to contemporary challenges but also work towards a healthcare system that prioritizes and values health and wellness above all else.
by Dr. Thomas Borer and Maximilian Skupien
1. Bundesamt für Gesundheit BAG. (2019). Gesundheitspolitische Strategie 2030. Retrieved from https://www.bag.admin.ch/bag/de/home/strategie-und-politik/gesundheit-2030/gesundheitspolitische-strategie-2030.html
2. VitalAire Canada. (2023). What is Value Based Healthcare? Retrieved from https://www.vitalaire.ca/about-us/what-value-based-healthcare
3. PricewaterhouseCoopers. (2020). Zukunft der Versorgungslandschaft Schweiz. Retrieved from https://www.pwc.ch/de/insights/gesundheitswesen/zukunft-versorgungslandschaft-schweiz-2020.html
4. eHealth Suisse. (2023). The electronic patient record | Professionals. Retrieved from https://www.patientrecord.ch/professionals
5. FMH Swiss Medical Association. (n.d.). Einheitliche Finanzierung (EFAS). Retrieved from https://www.fmh.ch/politik-medien/politische-geschaefte/einheitliche-finanzierung.cfm
Annex: Health2030 goals:
1. Leveraging Health Data and Technology;
2. Strengthening Health Literacy; Ensuring Care and Financing;
3. Healthy Aging;
4. Improving Quality of Care;
5. Containing Costs and Relieving Burdens on Low-Income Households;
6. Promoting Health through the Environment;
7. Promoting Health in the Workplace.