33 Chronically ill people need well-developed primary care, as a simulation model shows

In the first phase of the project, a system map of the current chronic care system was created in collaboration with research partners and decision-makers. This map represented a qualitative, conceptual model that visualised important influencing factors and their interrelationships in a system. Based on this, a quantitative simulation model was created in the second project phase, which mathematically recorded key factors and their relationships in the chronic care system. This made it possible to map the effects of four different scenarios in care.

Although more and more people are suffering from chronic conditions and need long-term care, the Swiss health care system is still strongly oriented towards acute care. To provide better care for this group of patients and to make more efficient use of limited health care resources, the health care system needs to be realigned to meet the actual needs. However, the design of such a reform is difficult due to the complexity of the health care system, technological progress, and the different health policy goals.

The aim of the study was to examine what effect the closure of general practices have on the use of medical services, costs and patients’ health and which patient groups and regions are particularly affected.

The four scenarios were each simulated over a period of ten years:

• In the first, pessimistic scenario, the number of primary care providers fell by 25 percent, while at the same time the proportion of the population with complicated chronic diseases increased by almost 25 percent, costs rose by 12.5 percent and patient satisfaction dropped by almost 50 percent. In addition, the job satisfaction of the service providers worsened by almost 30 percent.
• In the second, optimistic workforce scenario, the number of primary care providers rose by 15 percent and patient satisfaction doubled (plus 99 percent), while the other outcomes varied only marginally.
• In the third scenario, in which the proportion of primary care providers working in group practices increased by 70 per cent, only the job satisfaction of care providers changed significantly (plus 120 per cent).
• Finally, in the fourth scenario of digital transformation, patient satisfaction increased by about 25 percent, while the other factors remained almost constant.

Significance of the results for research and practice

The qualitative model developed in the study describes the current care system for chronically ill people. By means of the simulation model based on it, it was possible to show that the capacity of primary care is sustainably improved if the number of service providers in this sector increases. Furthermore, the simulation model can be used by relevant stakeholders to estimate future developments in the care system of chronically ill people and to evaluate planned health policy reforms or to develop new reform proposals. The study with its model thus offers an optimal platform for the continuous dialogue on the care of chronically ill people in Switzerland.

Projecting the impact of health policy changes for Swiss patients with chronic conditions using simulation modeling