Koordinationsleistungen durch die Spitex im Rahmen der integrierten Versorgung in der Schweiz

Spitex coordination is system-relevant

Spitex coordinates transitions, medication management, interprofessional case reviews, caregiver support, and care planning. It functions as a central interface in integrated care and identifies individual needs directly in the home setting.

Current reimbursement remains structurally inadequate

Coordination is reimbursable only under narrow conditions as an A-service. Telephone calls, prevention, social-organisational tasks, and in-hospital coordination are often not reimbursed, although Spitex performs these activities routinely.

Standardisation and digitalisation are required

Interviews show unclear definitions, insurer-specific billing processes, and missing digital interfaces. Proposed approaches include clearer regulation, mandatory shared digital records, new tariff positions, and case-based or complexity-adjusted reimbursement for coordination.

In the continuing education session “Koordinationsleistungen durch die Spitex im Rahmen der integrierten Versorgung in der Schweiz,” organized by Klinik Barmelweid, MSc in Nursing Science and MSc in Health Economics and Management Sibylle Fischbacher presents the relevance, current reimbursement framework, and systemic challenges of coordination services provided by Spitex. She explains that the increasing shift from inpatient to outpatient care, demographic ageing, and the rise in chronic and complex conditions substantially increase the need for coordination in home care. The lecture defines integrated care as cross-sectoral, interprofessional collaboration centered on the patient, and emphasizes Spitex as a key interface between medical, nursing, social, and organizational domains. Based on interview data from Spitex organizations and health insurers, MSc Sibylle Fischbacher shows that coordination is widely regarded as system-relevant but remains structurally and tariff-wise undercompensated. She details that current reimbursement under the Swiss mandatory health insurance system covers coordination only within narrow limits, particularly in complex or unstable care situations and mainly when performed by qualified nursing professionals, while many essential activities such as telephone coordination, prevention, and coordination during hospitalization remain non-billable. The presentation identifies major barriers including unclear legal definitions, heterogeneous insurer requirements, high administrative burden, lack of standardized digital interfaces, and the absence of a uniform definition of a complex case. As potential solutions, MSc Sibylle Fischbacher discusses tariff reforms such as case-based lump sums or complexity surcharges, broader recognition of advanced practice nurses and other professionals, mandatory digital health records across sectors, and financing models that better reflect quality, prevention, and actual coordination needs.