Stakeholder-perceived value and reimbursement pathways for a voice assistant in dementia care: evidence from Switzerland
Journal
Health Policy and Technology
Type
journal article
Date Issued
2026-08-25
Author(s)
Abstract
Objectives
Population ageing is driving up the prevalence of dementia and intensifying pressure on family carers and long-term care systems. Digital assistive technologies are widely promoted as part of the response, yet they seldom come with a workable reimbursement or implementation model. Using GRACE, an embodied voice assistant for people with dementia (PWD), as an empirical case, this study examines how stakeholder evidence can be translated into setting-specific reimbursement and implementation pathways within the Swiss healthcare system.
Methods
We conducted 23 semi-structured interviews with healthcare experts (n = 10), professional care staff (n = 9), insurance sector experts (n = 3) and one informal caregiver. German-language transcripts were analysed using codebook-informed thematic analysis and the Business Model Canvas. A policy-translation step distinguished participant statements, author inferences, and literature or policy input. Reporting follows COREQ.
Results
Stakeholders perceived potential value for PWD in companionship, cognitive activation, orientation and daily structure, and anticipated relief for caregivers. A pivotal finding was that home and institutional settings were expected to carry different requirements and therefore different payer logics. Financing was identified as the dominant barrier: basic mandatory insurance was seen as slow, costly and biased toward curative care, whereas out-of-pocket purchase, shared institutional ownership and supplementary or hybrid arrangements appeared more feasible in the near term. Caregiver acceptance, staff training and demonstrated effectiveness recurred as anticipated enablers.
Conclusions
Stakeholder evidence can translate perceived value into setting-specific reimbursement and implementation pathways, offering transferable guidance for assistive technologies whose benefits are expected to accumulate across users and care systems. For GRACE, we propose an exploratory pathway beginning with equitably safeguarded out-of-pocket deployment in home care, with movement towards supplementary, hybrid and, potentially, basic insurance contingent on evidence generation. A product split by care setting could align each variant with the payer most likely to benefit. The model is stakeholder-informed and requires validation with PWD and family caregivers.
Public Interest Summary
Dementia places growing pressure on families and on care services. Voice assistants may support people with early dementia, but it is often unclear who should pay for them and what evidence is needed. We interviewed 23 Swiss professionals, insurance sector experts and one family caregiver about GRACE, a research voice-assistant prototype. Stakeholders anticipated benefits such as companionship, daily structure and caregiver relief, but they had viewed a video rather than used the system. They expected home and residential-care settings to need different product designs and funding arrangements. We therefore propose an exploratory pathway that links each setting and expected benefit to a plausible payer and evidence requirement. Early self-pay or institutional use would require equity safeguards and cannot justify claims of cost savings. Because people with dementia were not interviewed and only one family caregiver participated, the findings describe stakeholder expectations and must be tested directly with intended users and families.
Population ageing is driving up the prevalence of dementia and intensifying pressure on family carers and long-term care systems. Digital assistive technologies are widely promoted as part of the response, yet they seldom come with a workable reimbursement or implementation model. Using GRACE, an embodied voice assistant for people with dementia (PWD), as an empirical case, this study examines how stakeholder evidence can be translated into setting-specific reimbursement and implementation pathways within the Swiss healthcare system.
Methods
We conducted 23 semi-structured interviews with healthcare experts (n = 10), professional care staff (n = 9), insurance sector experts (n = 3) and one informal caregiver. German-language transcripts were analysed using codebook-informed thematic analysis and the Business Model Canvas. A policy-translation step distinguished participant statements, author inferences, and literature or policy input. Reporting follows COREQ.
Results
Stakeholders perceived potential value for PWD in companionship, cognitive activation, orientation and daily structure, and anticipated relief for caregivers. A pivotal finding was that home and institutional settings were expected to carry different requirements and therefore different payer logics. Financing was identified as the dominant barrier: basic mandatory insurance was seen as slow, costly and biased toward curative care, whereas out-of-pocket purchase, shared institutional ownership and supplementary or hybrid arrangements appeared more feasible in the near term. Caregiver acceptance, staff training and demonstrated effectiveness recurred as anticipated enablers.
Conclusions
Stakeholder evidence can translate perceived value into setting-specific reimbursement and implementation pathways, offering transferable guidance for assistive technologies whose benefits are expected to accumulate across users and care systems. For GRACE, we propose an exploratory pathway beginning with equitably safeguarded out-of-pocket deployment in home care, with movement towards supplementary, hybrid and, potentially, basic insurance contingent on evidence generation. A product split by care setting could align each variant with the payer most likely to benefit. The model is stakeholder-informed and requires validation with PWD and family caregivers.
Public Interest Summary
Dementia places growing pressure on families and on care services. Voice assistants may support people with early dementia, but it is often unclear who should pay for them and what evidence is needed. We interviewed 23 Swiss professionals, insurance sector experts and one family caregiver about GRACE, a research voice-assistant prototype. Stakeholders anticipated benefits such as companionship, daily structure and caregiver relief, but they had viewed a video rather than used the system. They expected home and residential-care settings to need different product designs and funding arrangements. We therefore propose an exploratory pathway that links each setting and expected benefit to a plausible payer and evidence requirement. Early self-pay or institutional use would require equity safeguards and cannot justify claims of cost savings. Because people with dementia were not interviewed and only one family caregiver participated, the findings describe stakeholder expectations and must be tested directly with intended users and families.
HSG Classification
contribution to practical use / society
Refereed
Yes
Publisher
Elsevier BV
Volume
15
Number
10
Division(s)