Future Strategic Priorities of the Swiss Decentralized Healthcare System: A COVID-19 Case Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Disjointed Response: Zurich, Vaud, Ticino
3.1.1. Overview of the Pandemic Situation in Switzerland
3.1.2. Comparison of Zurich, Vaud, and Ticino
- Closure of schools, closure of workplaces, cancelation of public events, restriction of meetings, closure of public transportation, house arrest, restriction of domestic movement, international travel controls, public information campaigns, and face coverings. The nine sub-indices represented by the stringency index provide the correlation between the severity of pandemics in the cantons and the value of the index data.
3.2. Private Sectors in the Healthcare System: Challenges or Advantages?
3.2.1. The Importance of the Private Sector in the Swiss Healthcare System
3.2.2. Development of Private–Public Collaboration in Testing, Tracing, and Vaccination Policies
Contact Tracing: The SwissCovid App
Testing
Vaccination
3.2.3. Challenges in the Provision of Health Care Service during the Pandemic
3.3. Capacity of Central Authority
3.3.1. Decentralization in the Swiss Healthcare System
3.3.2. Advantages of a Central Authority during COVID-19 and Future Pandemics
3.3.3. Disadvantages of a Central Authority during COVID-19 and Future Pandemics
4. Discussion
5. Conclusions
6. Recommendations
- Greater emphasis on the collaboration between the public and private sectors, particularly between health care providers and health insurers. Greater collaboration would benefit both population health and disease prevention immensely by leading to a more equitable sharing of the risks associated with poor health and the benefits associated with good health and healthy lifestyles. This would require a solutions-based approach that considers health care resources and the better distribution, accessibility, and execution of health care services. Intelligent technologies alone can provide significant opportunities in decentralized systems, but trust in the respective government and citizen participation is a prerequisite for the long-term success of future health care challenges. Synergies should not be compromised by government involvement in the network of political parties, associations, interest groups, and lobbyists.
- Improved communication channels between governments, the public and private sectors, and the public. Different sectors operate under different constraints and regulations and approach problems in different ways, which can lead to impaired communication. Therefore, pandemic preparedness plans should establish direct communication channels between scientists and government agencies and between decision-makers and health care providers at different levels of government. This would enable active and comprehensive scientific communication that would improve timely decision-making and efficiency.
- Optimization of the healthcare value chain. To improve health care at all system levels, it is imperative to reduce the costs associated with care. This may seem counterintuitive, but it calls for the right incentives rather than emphasizing the wrong incentives. However, if risks and benefits are shared between providers and health insurers, providers could improve care—for example, by including more health-promoting services inside and outside hospitals—and reduce the number of disease services that the current system overwhelmingly provides. Prioritizing preventive care models and long-term cost-saving initiatives would not only reduce morbidity and mortality and save money later but would also start building strong provider–recipient relationships earlier and strengthen personal health accountability. Examples of trust-building structures could include college curricula with a preventive care focus or the provision of low-threshold community frameworks and health services that support long-term health behavior change [48]. In this sense, understanding and optimizing the healthcare value chain could help reduce patient admissions, prevent ICU overcrowding, provide sufficient treatment capacity, and reduce overall costs for hospitals and emergency departments.
- Promotion of the role of social determinants and health literacy. Prevention and basic health literacy should be more widely funded and promoted throughout society. Population compliance is greatly influenced by the level of health literacy that individuals bring to community discussions. Health literacy encompasses comprehension, numeracy, critical media literacy, and digital literacy and can contribute to a more comprehensive understanding of lifestyle or health choices and their impact on mental health, chronic disease management, substance use disorders, pregnancy, parenting, and younger population behaviors. Promoting health literacy could support overall confidence in and acceptance of public health interventions but may also increase demand for health care services.
- Application of the United Nations Sustainable Development Goals as a project catalyst and future-directed vessel. The SDGs provide powerful conceptual guidance for greater collaboration across sectors and more rigorous global standards for a sustainable future in all areas of work and life, particularly health, business, and policy. Given the unmet need to develop a pandemic preparedness plan, the context of the SDGs could be an opportunity to combine sustainable, long-term national programs with powerful requirements for emergency situations.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
GDP | Gross domestic product |
NPI | Non-pharmaceutical intervention |
SFG | Swiss Federal Government |
P1–P6 | Interview participants No. (n = 1–6) |
SFC | Swiss Federal Council |
ETH | Swiss Federal Institute of Technology in Zürich |
MHI | Mandatory health insurance |
THE | Total health expenditure |
NCS-TF | Swiss National COVID-19 Science Task Force |
FOPH | Federal Office of Public Health |
EPFL | École Polytechnique Fédérale de Lausanne |
GP | General practitioner |
SDGs | Sustainable Development Goals |
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Burger, M.M.-R.L.; Large, K.E.; Liu, Y.; Coyle, M.C.; Gamanya, C.T.; Etter, J.-F. Future Strategic Priorities of the Swiss Decentralized Healthcare System: A COVID-19 Case Study. Epidemiologia 2022, 3, 250-268. https://doi.org/10.3390/epidemiologia3020020
Burger MM-RL, Large KE, Liu Y, Coyle MC, Gamanya CT, Etter J-F. Future Strategic Priorities of the Swiss Decentralized Healthcare System: A COVID-19 Case Study. Epidemiologia. 2022; 3(2):250-268. https://doi.org/10.3390/epidemiologia3020020
Chicago/Turabian StyleBurger, Miriam Mi-Rim Lee, Kaitlin Elizabeth Large, Yiqi Liu, Melissa Cigdem Coyle, Cherish Tariro Gamanya, and Jean-François Etter. 2022. "Future Strategic Priorities of the Swiss Decentralized Healthcare System: A COVID-19 Case Study" Epidemiologia 3, no. 2: 250-268. https://doi.org/10.3390/epidemiologia3020020