04 Social inequalities in the provision of in-patient healthcare in Switzerland

The study identified associations between social factors, certain chronic diseases, the use of hospital care services and the quality of the associated results. This was done by linking existing anonymised medical and social data in a new database. The database comprised 1.2 million people aged 15 and over representing a total of 987,552 hospital stays in Switzerland in the period from 2010 to 2016. The database underwent comprehensive validation regarding correctness and completeness of the matched records. The correlations between the characteristics of inpatient treatment and follow-up care, social status and belonging to a vulnerable group then underwent statistical analysis. The findings were supplemented by focus groups with patients and professionals from the fields of medicine, migration and social affairs. They helped formulate recommendations for improving the quality of the care provided to vulnerable groups.

Data show that low social status is associated with a greater risk of falling ill and dying. In-depth knowledge about the relevant clinical pictures and medical treatments and about the care provided for affected groups within the population is needed in order to improve the quality of medical care. As yet, however, it has not been possible to study these interrelationships in Switzerland because the basic data have not existed. This is because healthcare data could not be linked to data from the social sphere.

The goal of the study was to link chronically ill people’s hospital data with data on their social situation so as to identify social disparities before they were admitted to hospital, during their hospital stay, at discharge and after their hospital stay. This provided the basis for recommending ways of optimising the inpatient care of vulnerable groups.

The study revealed social disparities at all stages of hospitalisation for chronic conditions:

• Before admission: People with a poor education, those living alone and the unemployed were at increased risk of hospitalisation.
• During hospital stay: Patients with poor language skills remained in hospital for longer. The same was true for patients with a poor education and limited social support, but this was (partly) attributable to their poorer health status.
• At discharge: Poorly educated or low-income elderly patients and people living alone were at increased risk of being admitted to a nursing home after being discharged from an acute hospital stay.
• After discharge: Patients with a low socio-economic status were at greater risk of unscheduled readmission.

All findings take account of age, gender and nationality and, where possible, health status, treatments and further factors as appropriate.

Significance of the results for research

The study is the first to use representative, nationwide, individual-level data to present findings on the effects of social inequality on hospital stays in Switzerland. The study also provides the basic material from which to derive suitable inpatient healthcare equity indicators for national health monitoring programmes.

Significance of the results for practice

The results show that in order to increase health equity and ease the burden on hospitals’ medical resources, patients with complex health and social burdens need targeted treatment and support that takes account of their social situation both during and after their hospital stay.

The findings point to the need to strengthen and expand social care within healthcare and to better coordinate the health and social care system. This includes:

1. Social situation screening on hospital admission and assignment of reference persons.
2. Interprofessional discharge planning and community interpreting.
3. Health insurance tariffs for professional social work in both outpatient and inpatient structures.

Social Inequalities and Hospitalisations in Switzerland SIHOS