Healthcare stakeholders' perspective on barriers to integrated care in Switzerland: Results from the open‐ended question of a nationwide survey

Abstract

Objective We aimed to identify the main barriers to integrated care (IC) as reported by healthcare stakeholders from various linguistic regions and health system specificities, according to their reality of practice. Methods Information was gathered through an open‐ended question from a national survey conducted in Switzerland in 2019. Responses were analysed qualitatively with the IRaMuTeQ software. Results Answers from 410 respondents were obtained. Respondents reported barriers at two levels: the system and professional level. Threat to financial benefits, concerns for patient data sharing and tensions between quality of care and benefits for patients versus costs were mentioned at the professional level, in their activity and in patient care. At the system level, limitations at the political level due to federalism and the lack of support and training for professionals were important barriers, in addition to the lack of recognition and compensation for professionals and the fragmented functioning of the health care system. Conclusion Our study underlines the importance of implementing innovative funding strategies and reimbursement schemes, as well as political willingness to move towards IC. The alignment between federal policies and cantonal specificities also appears as necessary to achieve involvement of professionals, promote integration of services and coordination of professionals for continuous and efficient care.

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“…Therefore, an efficient communication strategy with clear explanations for the population is needed, as most voters may not understand proposals on complex subjects such as healthcare. In Switzerland, where development of innovative health policy implementations has been under heated debates for a long time, 3 , 11 it is critical to identify the population groups that would be willing to accept changes, and to tailor the communication strategies accordingly.…”

Protocol for a mixed methods feasibility and implementation study of a community-based integrated care model for home-dwelling older adults: The INSPIRE project

“…In Switzerland, the development and implementation of integrated care initiatives are less advanced than in other European countries [26,27]. Previous authors suspected this is likely related to 1) the lack of a federal regulatory framework for integrated care and 2) features of the fragmented care system, partially driven by the structure and financing of care, e.g., responsibilities for health care are divided across three levels (federal, cantonal, and local) [26,27]. This has likely contributed to only smaller integrated care initiatives taking place in different local areas [26,27].…”

“…Previous authors suspected this is likely related to 1) the lack of a federal regulatory framework for integrated care and 2) features of the fragmented care system, partially driven by the structure and financing of care, e.g., responsibilities for health care are divided across three levels (federal, cantonal, and local) [26,27]. This has likely contributed to only smaller integrated care initiatives taking place in different local areas [26,27]. An additional challenge in Switzerland is that while there are many health and social offers available to older adults, they are not centrally coordinated or easy to navigate [28].…”