Forum for Health Policy · patient perspectives - Patient narratives (cave: blind spot: quality of...
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Institut für Biomedizinische Ethik und Medizingeschichte
The Swiss health care system – features, challenges and opportunities
Forum for Health Policy Stockhom, Sweden, 26 September 2017
Prof. Dr. med. Dr. phil. Nikola Biller-Andorno Institute for Biomedical Ethics and History of Medicine, University of Zurich, Switzerland
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Institut für Biomedizinische Ethik und Medizingeschichte
I. Features
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Institut für Biomedizinische Ethik und Medizingeschichte
- Federalism - Direct democracy- Multilingual- International orientation
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
• Wealthy country
• High life expectancy and quality of life
• Universal access to health care
• Comprehensive health benefit package
• Patient satisfaction with health care
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
Access Solidarity
Choice Personal responsibility
What seems to be working fairly well?
- Mandatory health insurance for a residents in Switzerland
- Universal access to a comprehensive benefit package
- Community rating - Subsidiaries for economically
weaker individiuals
- Insurance market (60+ insurers) > private on-top insurance > comparative platforms > programs/profiles (health competency, fitness apps etc.) - Different insurance models (standard: free choice
of physician, GP, telemedicine, managed care) - Range of annual deductibles (300 – 2500 CHF) - Co-pay (10%) and out-of-pocket expenses
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Institut für Biomedizinische Ethik und Medizingeschichte
„the Swiss model provides universal coverage in an insurance premium-funded system characterized by competition between independent insurers, competition between providers, consumer choice of health plan characteristics, and a high level of consumer responsibility.“
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Institut für Biomedizinische Ethik und Medizingeschichte
II. Challenges
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Institut für Biomedizinische Ethik und Medizingeschichte
- Mandatory health insurance for all Swiss residents.
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
2013
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Institut für Biomedizinische Ethik und Medizingeschichte
...
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Institut für Biomedizinische Ethik und Medizingeschichte
Core challenges1. The incidence of chronic diseases will increase > prevention, early detection, health promotion2. The way health care is delivered will have to change > better coordination, use of e-health, patient orientation 3. The financial basis of the continually growing health sector must be safeguarded > exhaust efficiency reserves (avoid duplication of services etc.)4. The lack of manageability and transparency must be eliminated > better data, collaboration between the federal government and cantons
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Institut für Biomedizinische Ethik und Medizingeschichte
III. Opportunities
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Institut für Biomedizinische Ethik und Medizingeschichte
What might work fairly well Patient empowerment:- information > evidence-based (quantitative and qualitative) > in plain language > unbiased by commerical interests- decision aids- suitable interfaces (EHR)/documentation of preferences
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Institut für Biomedizinische Ethik und Medizingeschichte
➢ Actively involve patients ➢ Create a culture that promotes openness and critical reflection ➢ Improve compensation and incentive structures ➢ Improve the existing certification process ➢ Carry out targeted data collection and analysis
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
21
Overdiagnosis/
- treatment
Enable informed choice - Comprehensive information - Fact sheets (for patients AND providers)
- State of the art risk communication - Decision aids
Better understanding of patient perspectives - Patient narratives (cave:
blind spot: quality of indication)
- Quantitative studies of patient expectations/preferences/values
Use of e-health (records) - Patient values in chart - Results of decision aids
as basis for face-to-face consultation
- Online platforms
Provider guidance - Training in
communication/SDM - Clinical practice
guideline reviews/guidelines for guidelines
- Performance indicators (coordination of care, quality of indication)
- Remove dysfunctional incentives
Circulus virtuosus
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
I
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Institut für Biomedizinische Ethik und Medizingeschichte
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Institut für Biomedizinische Ethik und Medizingeschichte
Accessibility
Afforda- bility
Choicequality
Trust
Sustaina- bility
Patient orientation
Appropriate care
Patient/ citizen engagement
Regulated competition
Solidarity
Consumer responsibility
Cooperation and integration Population
health needs
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Institut für Biomedizinische Ethik und Medizingeschichte
Thanks for your attention, and...
Prof. Dr. med. Dr. phil. Nikola Biller-Andorno Institute of Biomedical Ethics and History of Medicine
University of Zurich, Switzerland http://www.ibme.uzh.ch
... we are looking forward to
learning from Sweden!