Swiss Institute for Public Management
Recent publications
Since 72% of rare diseases are genetic in origin and mostly paediatrics, genetic newborn screening represents a diagnostic “window of opportunity”. Therefore, many gNBS initiatives started in different European countries. Screen4Care is a research project, which resulted of a joint effort between the European Union Commission and the European Federation of Pharmaceutical Industries and Associations. It focuses on genetic newborn screening and artificial intelligence-based tools which will be applied to a large European population of about 25.000 infants. The neonatal screening strategy will be based on targeted sequencing, while whole genome sequencing will be offered to all enrolled infants who may show early symptoms but have resulted negative at the targeted sequencing-based newborn screening. We will leverage artificial intelligence-based algorithms to identify patients using Electronic Health Records (EHR) and to build a repository “symptom checkers” for patients and healthcare providers. S4C will design an equitable, ethical, and sustainable framework for genetic newborn screening and new digital tools, corroborated by a large workout where legal, ethical, and social complexities will be addressed with the intent of making the framework highly and flexibly translatable into the diverse European health systems.
One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.
Lobbying ist in der Schweiz ein besonderes Phänomen, dessen Form und Mechanismen von den drei länderspezifischen Institutionen bestimmt werden: der direkten Demokratie, dem Föderalismus und dem Konkordanzprinzip. Diese Institutionen und die sich daraus ergebenden Strukturen und Prozesse, die es unterschiedlichen Akteuren erlauben, insbesondere im vorparlamentarischen Verfahren auf Politik und Verwaltung einzuwirken, werden in diesem Beitrag anhand von aktueller Literatur erläutert und kritisch diskutiert. Ziel ist es, den Leserinnen und Lesern einen umfassenden Einblick in die Lobbyarbeit in der Schweiz in unterschiedlichen Phasen des Gesetzgebungsprozesses sowie auch außerhalb dessen zu bieten.
Introduction Many countries report difficulties in preserving access to care in rural areas. This paper examines how hard-to-serve regions sustain care provision by transforming service delivery into population health systems. Theory and methods The paper builds on theory on care delivery in hard-to-serve regions. It presents a qualitative case study from the Lower Engadin, a rural high mountain valley in the Swiss Alps. Data sources include semi-structured interviews, participant observations, and documents. Data are analysed using recent conceptual research on population health systems. Results The case study illustrates how politicians and providers in the Lower Engadin resolved a care crisis and preserved access to care by forming a population health system. The system is organised around the Healthcare Centre Lower Engadin. Citizen-centred interventions target an aging population and include health promotion and prevention programs as well as case management based on an ambulatory-before-inpatient care strategy. Conclusion Hard-to-serve regions like the Lower Engadin preserve access to care by reorganising service delivery towards population health systems. The paper contributes to research on population health systems and care provision in rural areas.
External consultants in the public sector have gained increasing significance in Europe. They are understood as economic and societal experts, who deliver a mandated, ad hoc and paid consulting service to the public administration or political actors with a focus on processes or structures of public administration or on policies. Despite the importance of the topic, studies on the diffusion, role, processes and effects of management consultancy in the public sector are still scarce. Therefore, the chapter provides an overview of the topic, analyzing triggers, diffusion, content, actors, roles, and processes as well as evaluation and outcomes of public sector consultancy. In conclusion, public sector institutions are advised to reflect about the function of external consulting in their organization before the engagement.
Max Weber is undoubtedly one of the most seminal writers of Public Administration and his bequest for contemporary research and theory is impressive. Given the widespread misinterpretation of Weberian bureaucracy in the twentieth century administrative, managerial, and organizational scholarship, this chapter recapitulates Weber’s ideal-typical account of bureaucracy in the context of his epistemological, historical, and sociological reflections. The chapter then provides a discussion of salient traits of Weber reception in the twentieth century including the reception within U.S. scholarship. The latter is crucial as U.S. scholarship has shaped Weber’s bequest for European Public Administration in the sense of a re-importation. Finally, the chapter synthesizes the ‘original’ and the ‘reimported’ Weber with regard to our contemporary rediscovery of Weberian thought.
Most countries now share the prospect of an extended period of public fiscal austerity. Yet at the same time the demands for improved public services continues. This paper reviews the relationship between expenditure restraint and reform. It describes three broad strategies for achieving savings, noting that each has a different mixture of advantages and disadvantages. It then identifies four significant considerations that public service leaders will need to bear in mind as they decide their programs: timing, ethics, communications and legitimacy. The paper concludes with the observation that simultaneously tackling the needs for austerity and reform will call for extraordinary levels of public service leadership.
A geomorphologic kinematic-wave (GKW) model was developed for simulation of extreme floods from small alpine catchments. The GKW model couples the kinematic-wave theory and the geomorphologic representation of the catchment based on the Horton-Strahler ordering scheme. The model was tested on two small alpine catchments in Switzerland, and the agreement between simulated and observed floods was good. Care must however be taken with the computation of slope and roughness parameters. Copyright (C) 1999 John Wiley & Sons, Ltd.
A method to predict groundwater vulnerability to pesticide contamination on a regional scale has been developed and applied to a part of the upper Rhone river valley in Western Switzerland. Stochastic application of deterministic pesticide leaching models (Monte-Carlo), along with geostatistical interpolation techniques, were used to map both vulnerability levels and uncertainties. The various tested leaching models (numerical and analytical solutions of the convection–dispersion equation, capacitive model) lead to similar outcomes. The resulting maps show very high vulnerabilities. However, uncertainties are large, ranging from 20–30% for vulnerability indices between 0 and 1. Variations in pesticide properties (40–50%), water table depth (30–40%) and organic carbon content (20%) account for almost all the uncertainties on predicted contamination levels.
Flow processes in the mixing layer behind dunes provide the feedback between flow, sediment transport and the bed forms, which is assumed to be responsible for the development and persistence of dunes. It is attempted to classify these flow processes in terms of coherent structures, in which the vorticity of the upstream boundary layer is concentrated. Information from flow visualization is used to describe these vortical structures. The literature was reviewed to search for theoretical and experimental results of similar flow situations, which can provide the essential concepts.
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Bern, Switzerland
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Prof. Dr. Reto Steiner