1. Financing & reimbursement Care@Home
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Financing & reimbursement Care@Home

Care@Home enables hospital-equivalent care in patients' own homes. The project examines financing and reimbursement models to sustainably integrate this innovative form of care into the Swiss healthcare system.

Factsheet

Situation

The sustainable financing of hospital-substituting acute somatic care for adults in the home setting poses specific challenges for the Swiss health system. These models combine complex, interprofessional services for acute somatic episodes that would otherwise require hospitalization, while bringing together reimbursement logics that have so far remained separate: inpatient hospital care reimbursed through SwissDRG, outpatient physician services reimbursed through TARMED and, more recently, TARDOC and outpatient flat-rate payments, and minute-based home nursing care reimbursed under the KLV framework. The project systematically examined how such care models can be sustainably financed and reimbursed in Switzerland and aimed to develop evidence-informed health policy recommendations for pilot projects, service providers, health insurers, and cantons. The analysis was conducted from the perspective of public and mandatory payers and was guided by the Quadruple Aim framework, covering patient experience, health outcomes, cost efficiency, and healthcare workforce conditions.

Course of action

The project was based on a mixed-methods approach with three complementary components: 1. International comparison: A comparative policy-mapping analysis examined hospital-substituting acute somatic care in seven countries using a regulatory-incentive framework and derived implications for Switzerland. 2. Stakeholder engagement: Interviews and a workshop with relevant actors from service delivery, financing, and policy were conducted to capture existing arrangements, barriers, and design principles for implementation in Switzerland. 3. Swiss situational analysis: A quantitative analysis of the Swiss Hospital Medical Statistics (MedStat, 2021–2023) for five selected acute somatic conditions examined the hospitalization-shift potential into hospital-substituting care in the home setting.

Result

The project has created an evidence-based foundation for the further development of financing and reimbursement for hospital-substituting acute somatic care in Switzerland. To this end, international experience was systematically reviewed, the current Swiss situation was analyzed, and the shift potential for selected acute somatic conditions was quantified. The findings show in particular that current models in Switzerland operate at the limits of a fragmented reimbursement system and that no nationally routinized, broadly transferable, episode-capable cross-sector reimbursement pathway currently exists for hospital-substituting acute somatic care in the home setting. On this basis, key challenges and priority areas for sustainable implementation were identified. The project produced a project report, a policy brief, and country profiles for the countries included in the international comparison.

Looking ahead

The project results provide a foundation for the further development of hospital-substituting care in Switzerland. Further research is needed in particular for the development of an evidence-based catalogue of diagnoses suitable for acute care at home, as well as for the systematic analysis of patient preferences regarding home-based versus inpatient treatment. The findings can serve as guidance for cantons, service providers, insurers, and other actors in the further development of hospital-substituting care, particularly in the context of the EFAS reform, which opens a policy window for the further development of cross-sector reimbursement logics.

Contact

Prof. Dr. Katharina Blankart

  • Leiterin Gesundheitsökonomie & -politik
  • +41 31 848 67 89
  • Show e-mail

This project contributes to the following SDGs

  • 3: Good health and well-being