26.02.2020 Increased transparency leads to greater quality and safety
The FOPH has been committed to greater quality in the Swiss health service for many years. The new legal basis marks the start of a phase in which the focus is on more coordination and more transparency. In addition, the Federal Council is focusing on the reduction of healthcare-associated infections and the effectiveness of antibiotics.
Switzerland has one of the best healthcare systems in Europe. People here have a long life expectancy and receive efficient treatment. Yet there is still some way to go in terms of quality. Too many patients experience adverse events in Swiss hospitals. For example, they are given the wrong dose of a medicine. Many of these events result in no harm, but some are fatal. More quality in the health service would reduce the occurrence of adverse events and reduce costs. This is why the FOPH has been committed to greater quality for many years.
A lot of quality-related work is currently in progress. The partial revision of the Health Insurance Act (HIA), designed to enhance quality and cost efficiency, provides a new basis for this work. The HIA was approved by Parliament in June 2019 and the related ordinances will be drafted in the course of 2020. The partial revision regulates the following aspects:
Following consultation with the organisations involved, the Federal Council establishes objectives regarding the development of quality (redefined every four years).
The Act foresees the creation of a new Federal Quality Committee to support the Federal Council in promoting quality. This Committee will comprise representatives of the cantons, the service providers (e.g. doctors or hospitals), the health insurance providers and patient organisations. The Committee can request third parties to develop new quality indicators and to perform studies and quality development programmes. The Committee will be funded in equal parts by the Federal Government, the cantons and the insurers.
The Act also regulates the introduction of quality agreements that will need to be negotiated between the service providers and the insurers. The agreements will apply throughout Switzerland and cover aspects such as the way quality will be measured, what measures will be required to improve quality and what sanctions will be imposed if the agreements are not fulfilled.
Antibiotic resistance is another area in which the FOPH is seeking to enhance quality. The Strategy for Antibiotic Resistance (StAR) has been in place since 2016. The measures adopted under this strategy aim, among other things, to prevent the spread of resistant germs in the hospital setting. The emphasis is on three main activities: prescribing guidelines for the use of antibiotics, stewardship programmes to systematically review prescriptions of antimicrobial substances, as well as guidelines for the prevention and control of healthcare-associated outbreaks involving multiresistant pathogens.
In addition to the StAR strategy, the NOSO strategy aims to improve patient safety in the Swiss healthcare system. Some 6 % of patients develop an infection while they are in hospital (healthcare-associated infections [HAI]). The global objective of the NOSO strategy is to reduce hospital infections and prevent the spread of potentially dangerous pathogens in the in-patient setting. With this strategy the Federal Government and the numerous implementation partners are creating the basis and implementation tools needed to monitor, prevent and control HAI.
A lot was done in the past to counter HAI, but what was missing was a national system for monitoring the epidemiological situation and generally applicable, scientific standards for preventing and controlling HAI. Minimum structural requirements of this type for Swiss hospitals are currently being developed. Other future measures include the establishment of a national monitoring system for HAI. This monitoring will be developed as a series of modules and comprises at least the monitoring of catheter-associated bacteraemia (CLABSI) and catheter-associated urinary tract infections (CAUTI).