Abstract
BackgroundThe Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage. It is highly performing but expensive and health information systems are scarcely implemented. The Swiss Primary Care Active Monitoring (SPAM) program aims to develop an instrument able to describe the performance and effectiveness of the Swiss PC system.MethodsBased on a Literature review we developed a conceptual framework and selected indicators according to their ability to reflect the Swiss PC system. A two round modified RAND method with 24 inter−/national experts took place to select primary/secondary indicators (validity, clarity, agreement). A limited set of priority indicators was selected (importance, priority) in a third round.ResultsA conceptual framework covering three domains (structure, process, outcome) subdivided into twelve sections (funding, access, organisation/ workflow of resources, (Para-)Medical training, management of knowledge, clinical−/interpersonal care, health status, satisfaction of PC providers/ consumers, equity) was generated.365 indicators were pre-selected and 335 were finally retained. 56 were kept as priority indicators.- Among the remaining, 199 were identified as primary and 80 as secondary indicators. All domains and sections are represented.ConclusionThe development of the SPAM program allowed the construction of a consensual instrument in a traditionally unregulated health system through a modified RAND method. The selected 56 priority indicators render the SPAM instrument a comprehensive tool supporting a better understanding of the Swiss PC system’s performance and effectiveness as well as in identifying potential ways to improve quality of care. Further challenges will be to update indicators regularly and to assess validity and sensitivity-to-change over time.
Highlights
The Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage
Objective of the present study This study aims to describe the development of a monitoring instrument for the measurement of performance and effectiveness of the Swiss primary care (PC) system, the Swiss Primary Care Active Monitoring (SPAM) (Swiss Primary Health Care Active Monitoring) program
If more than 1/3 of the experts’ answers were in the extreme ranges of the scale, the indicator was considered with uncertain validity or was modified e.g. as not all the indicators were submitted for the second round as we decided not to resubmit indicators with high level of agreement, validity and clarity
Summary
The Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage. The 2011 OECD Health report (Organisation for Economic Co-operation and Development) stated that the Swiss health care system, a unique customer-driven fee-for-service system with universal coverage, is high performing [1]. In 2009, the Netherlands Institute for Health Services Research (Nivel) launched the PHAMEU collaboration (Primary Health Care Activity Monitor for Europe) [6] The purpose of this project was to develop a PC monitoring instrument that could be used in Europe and allows drawing comparison between countries. Following the model developed by Donabedian [7] the PHAMEU tool is organized classically into 3 main domains: structure, process and outcomes It is composed of almost 100 indicators grouped into nine main sections: governance, economics, workforce, access, comprehensiveness, continuity, coordination, quality and efficiency.
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