Preserving Care Delivery in Hard-to-Serve Regions: A Case Study of a Population Health System in the Swiss Lower Engadin.

Matthias Mitterlechner,Joachim Koppenberg,Céline Hollfelder

doi:10.5334/ijic.3353

Matthias Mitterlechner, Joachim Koppenberg + Show 1 more

Open Access

https://doi.org/10.5334/ijic.3353

Copy DOI

Abstract

Introduction:Many countries report difficulties in preserving access to care in rural areas. This paper examines how hard-to-serve regions sustain care provision by transforming service delivery into population health systems.Theory and methods:The paper builds on theory on care delivery in hard-to-serve regions. It presents a qualitative case study from the Lower Engadin, a rural high mountain valley in the Swiss Alps. Data sources include semi-structured interviews, participant observations, and documents. Data are analysed using recent conceptual research on population health systems.Results:The case study illustrates how politicians and providers in the Lower Engadin resolved a care crisis and preserved access to care by forming a population health system. The system is organised around the Healthcare Centre Lower Engadin. Citizen-centred interventions target an aging population and include health promotion and prevention programs as well as case management based on an ambulatory-before-inpatient care strategy.Conclusion:Hard-to-serve regions like the Lower Engadin preserve access to care by reorganising service delivery towards population health systems. The paper contributes to research on population health systems and care provision in rural areas.

Highlights

IntroductionThis paper examines how hard-to-serve regions sustain care provision by transforming service delivery into population health systems
Many countries report difficulties in preserving access to care in rural areas
Knieps et al [4] suggest that supply shortages should be addressed by questioning the traditional delivery system, and by developing new organisational models like population health systems, which “can make a d ecisive contribution to optimising care processes and preserving local care in the future” (p.9, our translation)

Summary

Introduction

Healthcare systems around the world are challenged by demographic aging and a growing number of patients with complex needs, and by regional disparities in care provision [1,2,3,4,5]. The data indicate an aging population with growing demand for inpatient long-term and ambulatory care services Given these needs, CSEB aims to create a system that reconciles the growing demand for care with the limited financial means of the Lower Engadin. The management team suggested merging the hospital and ambulatory care organisation into a foundation called CSEB, which would form an alliance with the thermal spa This would create opportunities for jointly developing new products, sharing expertise, coordinating patient activities, and realising cost synergies by centralising shared services. The management team launched an initiative to create new health tourism services in collaboration with the regional tourism association and providers including hotels, restaurants, and businesses They aimed to attract new extra-regional clients and patients co-financing CSEB’s and network members’ fixed costs during the low season. Noted a Regional Council member, “I believe that CSEB contributes a lot that the region grows together even stronger than before.”

Discussion

Findings

Conclusion