Article
Hospital at Home – A model with a future
Home care has been firmly established in Switzerland for some time. Organisations such as Spitex provide a comprehensive range of home care services. In contrast, the concept of Hospital at Home is still in its infancy. How will this change in the coming years? We have explained this in a white paper based on specialist literature and insights from various expert discussions.
Hospital at Home: Definition
Hospital at Home is an extension of standard home care: Patients with an illness that usually requires hospitalisation are treated in their home environment. The decentralised concept places the patient at the centre and requires co-operation between different stakeholders such as hospitals, doctors, pharmacies, insurance companies and Spitex.
A glimpse into the future
The year is 2040 and Angela Meier has fallen ill with pneumonia. After consulting with doctors and her health insurance provides, she decides - instead of inpatient treatment in hospital - to opt for Hospital at Home. Every day, nursing staff and, if necessary, a doctor come to her home to administer the necessary treatment. Angela is also monitored around the clock by telemedicine from the hospital.
The treatment is successful, but a few years later Angela Meier is once again unlucky with her health: she has to undergo heart surgery. This can only be performed in hospital. After only a few days, however, she returns to the Hospital at Home. Nursing staff visit Angela at home several times a week and she communicates regularly with the doctor in charge, who constantly monitors her condition with wearables from the hospital.
The case study illustrates this: the Hospital at Home concept could usefully complement the existing treatment and care services. In the future, patients would be able to choose whether to be treated at home or in hospital for certain treatments and interventions. This would allow individual needs to be better considered and the healing process optimised. In addition, hospital stays could be shortened thanks to new infrastructure and technical possibilities as patients could also recover safely at home.
Why home care and Hospital at Home will play a central role in the future
Various developments point to the increasing importance of Home Care and Hospital at Home.
Challenges and solutions
As the interviews with representatives of hospitals, health insurance companies, associations and politicians show, the Hospital at Home concept could play a more important role in Switzerland in the future. All interviewees agreed with this. However, many questions remain unanswered when it comes to implementation. The experts see the biggest challenges in the following areas:
- Interoperability is technically possible – cooperation is the challenge. For this, the incentives must be right.
- Currently strong silo mentality of the individual stakeholders
- Responsibilities must be clearly defined
- Data protection: who has access, when, and for what purposes?
- What legal structure is needed for Hospital at Home?
- Shortage of skilled nursing staff is likely to increase further
- Hospital at Home is labour-intensive
- Adjustment of fees: Hospital at Home is not economically feasible in the current fee system
- Conflict of goals: relieving infrastructure through Hospital at Home vs. high staff requirements of Hospital at Home
- Billing via supplementary insurance?
- Hospital at Home is only feasible under suitable circumstances ((symptoms, environment, domestic situation etc.).)
- Technical problems, internet connection, cybersecurity
- Danger of increased volumes of unnecessary treatments due to convenience?
Next stage: pilot projects
To analyse the benefits and risks of the Hospital at Home model in Switzerland, long-term pilot projects are needed to gain valuable experience. With a positive evaluation, projects could be successively expanded.
Just as important as the regulatory framework is the increased cooperation of investors and partners on the part of hospitals, health insurance companies and Spitex. They must all be prepared to work together to develop a holistic concept for Hospital at Home and to clarify the legal and technical issues. Only when the central stakeholders gain experience in the network will they be able actively to shape the future of the healthcare system.
Download the full study (PDF) hospital at home
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