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Revision of Article 58 KVG: Strengthening quality and efficiency

The revision of Article 58 KVG to strengthen quality and efficiency came into force on April 1, 2021. The aim is to achieve a systematic and structured improvement in the quality of services (Health insurance: Quality development in Switzerland). It thus strengthens the quality development requirements that must be met by service providers admitted to compulsory health insurance OKP (Art. 35 types of service providers).

Article 58a KVG: A pact for quality

The new legal basis has created instruments for the systematic and coordinated further development of quality in the Swiss healthcare system. Article 58a of the KVG (Art. 58a Measures by service providers and insurers for quality development) defines the measures for this. Among other things, the associations of service providers and insurers are called upon to conclude nationwide quality development contracts. These quality contracts are not only a commitment to excellence, but also an instrument for ensuring the continuous improvement of patient care. They define quality measurements, measures to improve quality and set a framework for cooperation and review of these measures. If no agreement is reached, the Federal Council acts as the regulatory authority to issue the necessary regulations.

Articles 58g and 58d KVV: The quality benchmark

Article 58g of the KVV supplements the provisions of the KVG by defining specific quality requirements that serve the formal approval procedure of the cantons (Art. 58g Quality requirements).

The service providers must meet the following quality-related requirements for their authorization, which guarantees high-quality and appropriate services:

1. You have the necessary qualified personnel.
2. You have a suitable quality management system in place.
3. They have a suitable internal reporting and learning system and, where such a system exists, have joined a uniform nationwide network for reporting adverse events.
4. They have the equipment required to participate in national quality measurements.

Since January 1, 2022, outpatient service providers who apply for a new license to operate at the expense of the OKP must meet all licensing requirements, including the quality requirements in accordance with Art. 58g KVV.

For outpatient service providers who have already been approved, the acquis in accordance with paragraph 2 of the transitional provisions of the KVG amendment of 19 June 2020 (Frequently Asked Questions (FAQ) on the implementation of the KVG amendment “Authorisation of service providers”) applies). With regard to the quality requirements, however, the current negotiations on the quality contracts between the associations of service providers and insurers (Art. 58a KVG) will be decisive and must be complied with by all service providers and for the entire duration of the authorisation.

Inpatient facilities such as hospitals, nursing homes, etc. must in turn meet all quality requirements in accordance with Art. 58d KVV. In addition to the same four points listed in Art. 58g KVV, a fifth is also required:

5. The facility is equipped to ensure medication safety, in particular by electronically recording prescribed and dispensed medicines.

(Art. 58d Assessment of economic efficiency and quality)

Art. 58d KVV focuses on planning criteria: for example, only hospitals or nursing homes that meet the conditions in Art. 58d KVV are included on the corresponding list or receive a service mandate. When selecting the facilities to be included on the list, the cantons must take into account the criteria of economic efficiency and quality of service provision as a prerequisite for cost-effective and high-quality service provision.

Conclusion

Article 58a KVG and KVV Articles 58g and 58d form the foundation of the Swiss healthcare system. The revision of the KVG underlines the desire to further strengthen quality and efficiency in the healthcare system and to adapt medical care to the needs of society.

This reflection is intended to provide a deeper understanding of the complex mechanisms at work behind the scenes of a progressive healthcare system. It is an interplay of legal requirements and the commitment of all stakeholders that make sustainable, high-quality healthcare possible.

Our CIRS – your reporting and learning system with connection to the national network of the Swiss Patient Safety Foundation

As leading experts for various reporting systems in the Swiss healthcare sector, we can help you to meet the legal quality requirements described above easily and efficiently with our wide range of innovative software solutions. Whether you are an inpatient facility, group practice, individual company or association, thanks to our many years of experience and cooperation with the Swiss Patient Safety Foundation, we can offer you the right CIRS solution for you with a direct connection to the national CIRS network, which has been operated by the Swiss Patient Safety Foundation since 2010. The network comprises over 300 hospitals, clinics, care homes and outpatient facilities that share their CIRS reports and work together to develop solutions. The network is financially supported and scientifically monitored by the Federal Office of Public Health (FOPH).

And as an inpatient facility, we also offer you our H-VIGILANZ to fulfill point 5 on medication safety in accordance with Art. 58d KVV.

Do you have any questions? The links below to our product pages will provide you with further information. And please do not hesitate to contact us directly. We will be happy to support you.

Important links:
Reporting and learning system | H-CIRS Starter
CIRS reporting system| CIRS outpatient
CIRSoutpatient – patient safety
Vigilancereporting system for the medical sector