Hospital capacity planning must balance competing priorities: quality, healthcare expenditures, and accessibility. While concentrating services enhances outcomes and efficiency (e.g., through volume-outcome relationships and economies of scale), it often compromises accessibility, particularly in rural or underserved areas. These challenges are further complicated by geographic (e.g., urban vs. rural areas), demographic, and service-specific factors (e.g., emergency vs. elective care), requiring a targeted, differentiated, and balanced approach.
In Switzerland, the 2012 revision of the Health Insurance Act (KVG) sparked the development and introduction of a structured approach to cantonal hospital planning. It is based on service groups (SPLG) and quality requirements for service mandates, while service groups for highly specialized medicine (HSM) are regulated at a national level. Since this last revision, healthcare expenditures continued to rise, and are likely to also continue rising in the next decades, especially due to demographic change. At the same time, quality variation and service fragmentation persist for a number of service groups.
Thus, we aim to develop evidence-based policy recommendations to inform a new reform of Swiss hospital capacity planning, exploring three research questions:
(1) Should alternative planning areas or regions be considered for different service groups?
(2) Under what conditions would cantons engage in intercantonal planning for selected services?
(3) What role should need-for-care analyses play in capacity planning, particularly when considering changes in planning areas?
Prof. Dr. Alexander Geissler, Dr. Justus Vogel, Dr. David Ehlig, Enqi Fu, Charlotte Schneider
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Groupe Mutuel Foundation
December 2024 – December 2025