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Thematic Areas

The Swiss Learning Health System (SLHS) with its partners is continuously developing policy briefs and stakeholder dialogues.

Topics for Policy Briefs and Stakeholder Dialogues have been selected by means of a prioritization process taking into account their scientific and policy relevance. Topics underline the interdisciplinarity of health sciences and health systems research by including disciplines such as medical science, economics, communication, law, public health and theology.

Policy Briefs and Stakeholder Dialogues of the SLHS focus on different thematic areas. Thematic areas are based on the expertise of the academic network in the SLHS, and are closely aligned with the system building blocks described in the WHO Health Systems Framework and the Federal Council’s health policy strategy 2020–2030 Health2030.

 

Health Systems Framework

The conceptual framework for the Swiss Learning Health System (SLHS) is given by the «health systems’ building blocks» and the concept of the «learning health system». 

The systems thinking approach for health systems strengthening inspires the SLHS dynamic architecture and interconnectedness as well as the central role that people play within the system, as shown in the figure on the right.


The WHO Health System Framework
(figure adapted and based on:
“World Health Organisation 2007”)

Service delivery – effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources

Health workforce – responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances

Health information system – production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status

Medicines and technologies – equitable access to essential medical products, vaccines and other technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use

Health care financing – adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them, with incentives for providers and users to be efficient

Leadership and governance – strategic policy frameworks combined with effective oversight, coalition building, regulation, attention to system design and accountability

 

Fekri O, Macarayan ER, Klazinga N. (2018). Health system performance assessment in the WHO European Region: Which domains and indicators have been used by Member States for its measurement?

World Health Organization (2007). Everybody's Business: Strenghtening health systems to improve health outcomes: WHO's framework for action.

World Health Organization (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies.

Although tremendous technological advances in the health sector have contributed to large improvements in population health, only little innovation has occurred in the way health services are delivered.

Complex cases in the provision of care need new fit-for-purpose approaches.  The Active involvement of patients in decision-making will support the development of integrated care solutions, lead to better health outcomes and higher quality of services. From a health systems perspective, key elements to achieve these goals are inter-sectoral collaboration and interprofessionality. People should be at the center of service provision: for the SLHS this translates into the optimization and scaling up of community services, and the delivery of appropriate care, including “choosing wisely” strategies.

In response to chronic conditions and the emerging needs of an aging population, the SLHS coordinates research projects strengthening the provision of rehabilitation services in Switzerland.

The Swiss health care system is currently challenged to rethink of the organization of effective and efficient rehabilitation services, the availability of a suitably trained workforce, novel solutions in rehabilitation financing, and the mainstreaming of functioning information in health information systems.

Given the growing prevalence of chronic health conditions, health promotion and disease prevention are effective and basic ways to prevent, reduce or mitigate the burden of disease and promote well-being. This involves but is not limited to the promotion of behavioral determinants, such as physical activity, healthy diet, the reduction of excessive alcohol consumption, substance use, and media consumption.

Over the life course, health literacy and access to evidence-based health information are critical for informed decisions and coping with societal, environmental and personal challenges. Of particular relevance is the broad health system perspective with its socio-economic, environmental and contextual factors.

In this context, research conducted by the SLHS partner institutions helps to better understand the health system mechanisms and health determinants in order to support the development of new strategies to promote health and prevent disease.

The Swiss health system is rated among the best in the world. High quality of care, guaranteed access to necessary health services, and coverage through statutory health insurance are considered major strengths of the system.

However, important inequalities throughout the health system also exist, some of which may be unavoidable (e.g. genetic variations). On the other hand, inequalities that can be avoided are defined inequities and call for action. Inequities include socio-economic conditions influencing health status and health services access, as well as exposure to environmental hazards. The Swiss government has responded to this by defining equality of opportunity as one of the four priority areas on the health policy agenda.

Researchers in the SLHS seek to expand the evidence base on the origins of health inequalities in Switzerland and contribute to the development of new programs and interventions to reduce health inequities.

Health systems decisions on health workforce, financing, and leadership are equally important and may have direct and/or indirect consequences for society and individuals’ health.

However, developing recommendations and guidelines on a systems level poses distinctive challenges. Even if good evidence exists, the uptake of health system recommendations heavily depends on the context, policy process, political economy, and decision culture. The implementation of effective health systems guidance requires transparent and systematic methods and suitable information systems to inform decision-making.

The SLHS coordinates a number of projects that develop novel tools for health systems guidance, applying the principles of systems thinking, and new methodology, technology and standards supporting health intelligence.

The health sector is one of the fastest growing sectors in Switzerland, outpacing the growth of the overall economy and posing an increasing burden on public and private spending. Fragmentation of the health system at both the financing and delivery level increasingly leads to wasted resources and suboptimal outcomes. There is also growing realization that more care and/or expensive care does not always mean better care.

Systematic and transparent evaluation of costs-benefits of interventions, policies and programs, and suitable incentives to reduce economic inefficiencies are crucial for care affordability. This can be in terms of inpatient and outpatient care financing, design of health insurance and premium subsidies for low-income households, and organization of the social security system. The SLHS research seeks to contribute to a better understanding of the sources of inefficiency and inform policy makers about suitable reforms.

The functioning of health systems crucially relies on a legal framework that can flexibly respond to emerging needs, learn and constantly improve itself in light of ethical considerations. Research activities on this are supported by the SLHS.

There are still many areas within the Swiss health system that require more attention from policy makers and researchers alike. Areas include, for example, human subjects research and the protection of personal (health) data, regulations of pharmaceutical products, gene technology and genetic testing, or legal aspects related to end-of-life decisions. Equally relevant are guidelines for ethical decision-making, from the perspective of individuals, organizations, governments and the health system as a whole. This includes aspects of patient care, such as counselling, psychotherapy or pastoral care, responsible organizations as well as fair access to health services and just resource allocations. The SLHS supports a variety of research activities that seek to enhance the legal and ethical framework in Switzerland on all levels of the health system.

Capacity building

The availability of well-trained and capable scientists is essential for establishing a successful and sustainable learning health system.

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