The Health CH Symposium, organised by the Faculty of Medicine's Health Organisation Management courses, tackled a subject that is crucial to the viability of the Swiss health system: how can we develop and strengthen healthcare networks able to respond equitably to the needs of the population, while keeping costs under control?

Ensuring continuity of care

Integrated care refers to the organisation of health services that provide coordinated, effective, high-quality continuity of care, from prevention to treatment, including palliative and rehabilitative care. This model of care is based on structured collaboration between professionals, institutions, patients and their families, and insurance organisations to ensure a coherent care pathway that is better adapted to individual needs. This also means making greater use of digitisation and information sharing.

But how can we achieve a system that is truly patient-centred? What political, financial and organisational obstacles need to be overcome? And what are the points of hesitancy, and even rejection, come from the general public that could derail a system designed to be efficient by healthcare professionals?

"Today, integrated healthcare networks are springing up all over Switzerland, but these local initiatives are developing in silos, taking a variety of forms and remaining unevenly distributed across the country", explains Karl Blanchet, director of the programme and professor at the Faculty of Medicine. "This fragmentation prevents us from having clear information about their effectiveness and any potential pitfalls. That's why a symposium like ours is so important: to bring together experts around the same table to share experiences and develop common solutions.”

Ethical and technological implications

As in almost every area of society, the massive arrival of artificial intelligence is a source of opportunity, but also of concern. "It is essential to take a calm look at the risks of transforming the healthcare system, particularly in terms of the loss of technological sovereignty, the lack of support for prevention and health promotion, and the lack of reflection on sustainability in terms of human resources, as well as climate and planetary limits," stresses Bertrand Kiefer, a physician and ethicist and the symposium’s keynote speaker. 

This provided food for thought for the panel of experts, made up of public health specialists and an insurance representative, who saw artificial intelligence and health promotion as key issues, as well as the sense of loss of meaning that many physicians feel. "These are not new observations, particularly when we look at the evolution of healthcare work and professions", says Ingrid Gilles, co-PI for the SCOHPICA study coordinated by Unisanté, which aims to understand the career paths and experiences of healthcare professionals. "For a healthcare system to work, it is essential that the concerns of healthcare professionals are heard and taken into account.” The example of the Beluga pilot project, an innovative cantonal public health insurance scheme planned for Geneva, highlighted other obstacles to the integration of care, starting with the legal limitations at the very core of compulsory health insurance (LAMal).

Training and transformation at the heart of tomorrow's care

The landscape of integrated care networks is currently vast and fragmented. There are primary care networks, primary care companies, health regions, patient networks and virtual networks, all based on different types of patients and professionals. To function properly and stabilise costs, it is vital to include a critical mass of patients and professionals within the same structure. Multidisciplinary teamwork requires training, which is currently lacking in undergraduate curricula. Integrated care is not just about technical or financial issues: it is also about human and organisational transformation. There is an urgent need to train, equip and support healthcare managers with an approach based on data, collaborative practices and a system-wide vision. 

These challenges underline the importance of research in the field of integrated care, carried out in particular by the Swiss Forum for Integrated Care (fmc), which is working on a common typology of the different models of integrated care - for example, care networks, managed care organisations and alternative insurance models – and, at the UNIGE Faculty of Medicine, the brand-new research group on the management of healthcare organisations (HOM Lab), headed by Mathias Waelli, which aims to support those responsible for healthcare as part of a far-reaching transformation of the system and to formalise academic research that can support political decisions in this area. The 2^nd HealthCH symposium highlighted a shared desire to innovate and work together to build the future of healthcare in Switzerland, towards a more integrated, equitable and population-centred system.