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

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  • Baumann, Aron
  • Wyss, Kaspar

Abstract

The shift from inpatient care to the ambulatory sector is a central aspiration of European health systems. Despite demonstrated benefits, health reforms have struggled to realize their potential. In this context, we discuss recent hospital sector reforms in Switzerland and analyze the content, process, and role of evidence in the recent introduction of policies to substitute inpatient care with ambulatory care. The prevailing payment system incentivized hospitals to provide unnecessary and costly inpatient services, but federal reform on tariff structures was deemed politically unfeasible. Instead, driven by the pressure to contain costs, cantonal and federal health authorities began to deny reimbursement for selected inpatient procedures in 2017. These regulatory measures were effective in reducing inpatient admissions and health care costs. This case study illustrates that clear, simple messages about hospital sector reform can raise awareness of the need for change. However, the evidence used in the policy process was limited and not critically reviewed. Stakeholders used long-standing international comparisons of inpatient substitution potential to legitimize policies, but not to develop them. The analysis restates the importance of inter- and intranational comparative analyses and institutions such as health observatories and suggests aligning health system governance more proactively with international developments.

Suggested Citation

  • Baumann, Aron & Wyss, Kaspar, 2021. "The shift from inpatient care to outpatient care in Switzerland since 2017: Policy processes and the role of evidence," Health Policy, Elsevier, vol. 125(4), pages 512-519.
  • Handle: RePEc:eee:hepoli:v:125:y:2021:i:4:p:512-519
    DOI: 10.1016/j.healthpol.2021.01.012
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    References listed on IDEAS

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    1. Przemyslaw Marcin Sowa, 2016. "Governance of Hospitals in Central and Eastern Europe," Springer Books, Springer, edition 1, number 978-981-287-766-6, January.
    2. Dubas-Jakóbczyk, K. & Albreht, T. & Behmane, D. & Bryndova, L. & Dimova, A. & Džakula, A. & Habicht, T. & Murauskiene, L. & Scîntee, S.G. & Smatana, M. & Velkey, Z. & Quentin, W., 2020. "Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis," Health Policy, Elsevier, vol. 124(4), pages 368-379.
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    Cited by:

    1. Valentelyte, Gintare & Keegan, Conor & Sorensen, Jan, 2023. "Hospital response to Activity-Based Funding and price incentives: Evidence from Ireland," Health Policy, Elsevier, vol. 137(C).
    2. Franck Jaotombo & Vanessa Pauly & Guillaume Fond & Veronica Orleans & Pascal Auquier & Badih Ghattas & Laurent Boyer, 2023. "Machine-learning prediction for hospital length of stay using a French medico-administrative database," Post-Print hal-04325691, HAL.
    3. Kreutzberg, Anika & Eckhardt, Helene & Milstein, Ricarda & Busse, Reinhard, 2024. "International strategies, experiences, and payment models to incentivise day surgery," Health Policy, Elsevier, vol. 140(C).

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