The shift from inpatient care to outpatient care in Switzerland since 2017: Policy processes and the role of evidence

Baumann, Aron; Wyss, Kaspar

doi:10.1016/j.healthpol.2021.01.012

Cited by 18 publications

(12 citation statements)

References 6 publications

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“…The out-of-pocket expenses of diabetes patients is also reduced in the meantime. These discoveries are similar to the results of previous studies [ 44 , 45 ]. Besides this, the outpatient expenses decrease as well, which further verifies the positive role of outpatient services in disease prevention, health outcomes promotion, treatment effectiveness improvement and medical expenses reduction.…”

Section: Discussionsupporting

confidence: 93%

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Liu

2022

Int J Equity Health

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Background: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. Methods: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients’ medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients’ health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. Results: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient’s annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient’s annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient’s annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn’t change. Conclusion: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.

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Section: Discussionsupporting

confidence: 93%

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Liu

2022

Int J Equity Health

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“…The shift from inpatient to ambulatory / home care witnessed in Switzerland over the last decade [1] has led to an increase in the prevalence of complex care situations in home care settings [27]. Complexity can be defined as a multidimensional concept involving interactions between biological, socioeconomic, cultural, environmental and behavioral forces as health determinants [28].…”

Section: Complexity In Home Care Practice: Toward Nurses' Assessments...mentioning

confidence: 99%

Assessing multidimensional complexity in home care: congruencies and discrepancies between patients and nurses

et al. 2022

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Background Person-centered care allows for the inclusion of the totality of a person’s needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings. Methods The COMID-P and the COMID were completed during the fraXity study at the patients’ homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC). Results A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]). Conclusions The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients’ needs. Trial registration The fraXity study was registered in ClinicalTrials.gov, NCT03883425, on March 20, 2019.

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“…Ce « virage ambulatoire » permettrait un meilleur maintien des patients à domicile, évitant aussi les effets délétères des hospitalisations sur la fonctionnalité des personnes âgées, une stabilisation des coûts et une meilleure coordination des parcours de soins impliquant de multiples professionnels. 4 Cela se concrétise sur le terrain par l'élaboration de nombreux programmes proposant innovations et transformations des soins primaires à travers le monde. L'étude de Jimenez et coll.…”

Section: Interventions Pour Le Renforcement Des Soins Primairesunclassified

Organisation des soins en médecine de famille : quoi de neuf dans la littérature scientifique en 2020 ?

Cohidon¹,

Senn²

2021

Revue Médicale Suisse

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Cet article présente une sélection d'études marquantes publiées, en 2020, qui explorent différents aspects du fonctionnement et de l'organisation de la médecine de famille dans le monde. Cette année, deux revues de littérature sont présentées. Elles concernent les interventions à large échelle permettant de renforcer les soins primaires et la vision de la collaboration interprofessionnelle par d'autres professionnels que les médecins. Un troisième article porte sur le lien entre la régularité des visites chez le généraliste et les hospitalisations. Enfin, impossible d'échapper à un article en lien avec la pandémie de Covid-19 cette année ! Celui proposé ici synthétise le rôle potentiel des soins primaires dans la réponse à la pandémie. Organization and practice in family medicine :What's new in the 2020 literature ?This is a selection of some important studies published in 2020 dealing with several key organization and functioning features of family medicine. This year, two literature reviews are presented. They deal with large-scale interventions to strengthen primary care and the view of interprofessional collaboration by professionals other than physicians. A third article focuses on the link between regular visits to the general practitioner and hospitalizations. Finally, it is impossible to avoid an article related to the COVID-19 pandemic this year! This one synthesizes the potential role of primary care in the response to the pandemic.

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The shift from inpatient care to outpatient care in Switzerland since 2017: Policy processes and the role of evidence

Cited by 18 publications

References 6 publications

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

Assessing multidimensional complexity in home care: congruencies and discrepancies between patients and nurses

Organisation des soins en médecine de famille : quoi de neuf dans la littérature scientifique en 2020 ?

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