Managed care

The term managed care refers to the integrated care of patients. This essentially means that the individual steps in a patient’s treatment that are often provided by different service providers such as general practitioners, physiotherapists, specialist doctors, etc. are coordinated and aligned with each other by a central entity.

Integrated medical practices and treatment centres can offer the full range of medical expertise required to treat a clinical condition. Yet integrated care by no means stands exclusively for networks of doctors; it rather means autonomy and shared responsibility for a budget. In addition, integrated care must be given by service providers who join forces to form a care network that also regulates cooperation with third parties.

In Switzerland too, teamwork and networking between doctors are viewed as models of the future. In an insurance model of this type, insured individuals benefit from premiums that are lower than those paid in conventional models. In June 2012, the electorate in Switzerland rejected the managed care component of the HIA revision with a resounding 76 percent majority. Despite this setback, integrated care models are making headway.

Increased quality and efficiency

Integrated care models can help to improve the quality and cost-effectiveness of care. The importance of managed care in Switzerland has grown, not least against the background of rising costs in the healthcare system. Inadequate care not only endangers the health of the population, it is also the cause of innumerable avoidable complications and deaths. Integrated care models are designed to improve quality and cost-effectiveness. The parameters by which their success is measured are overall outcomes in patient therapy and management. Integrated care models play a particularly significant role in the management of chronic diseases. The following elements are common to all worthwhile integrated care models:

• Alignment with the patient’s needs: Care is organised in such a way that it increases the benefit to the patient.
• Quality orientation: The objective of integrated care is to improve the quality of care.
• Focus on chronic diseases: Chronic diseases account for a small percentage of all insurance cases but cause disproportionately high costs.
• Freedom of choice: Insured persons and service providers should be able to choose freely between the two models – integrated care and conventional care – within the basic insurance system.
• Incentives: Service providers should be able to benefit financially from good care outcomes.
• One-stop healthcare: The integrated care network is the point of contact for patients who choose this model.
• Autonomy and shared budget responsibility: Integrated care is given by service providers who join up to form a care network. The network regulates cooperation with third parties (integrated care models certainly don’t have to be networks of doctors).
• Risk equalisation: This must be established in such a way that chronically ill individuals are an attractive proposition for insurers.