Research - 25.02.2026 - 09:00
Switzerland is one of the countries with the highest hospital densities in Europe, as reported by the NZZ. However, with a comparatively average number of beds per capita, there are an above-average number of locations. This leads to inefficiencies: most clinics have too low a utilisation rate and are therefore in the red.
In Switzerland, the hospital landscape is largely shaped by cantonal hospital planning. With the help of hospital planning performance groups (SPLG), the cantons determine which hospitals are allowed to offer which services. This is a complex undertaking, as it requires balancing appropriate access for the population, high-quality treatment and economic viability for the hospitals.
But what would better hospital planning look like? To answer this question, researchers at the University of St.Gallen first examined how well current hospital planning fits with observable patient flows and service mandates. In addition, they investigated whether the SPLGs reflect the complexity and urgency of treatment and how they can be assigned to geographical planning levels.
Many hospitals are currently under economic pressure. Added to this are a shortage of skilled workers and increasing demands for quality and efficiency. Against this backdrop, the question arises as to whether hospital planning, which is primarily based on cantonal boundaries, still adequately reflects the actual realities of healthcare. “Canton boundaries play a minor role for many patients when it comes to choosing where to receive treatment,” says Alexander Geissler, author of the study and professor of health economics at the University of St.Gallen.
The study “The Future of Swiss Hospital Capacity Planning” is based on medical data from the Federal Statistical Office. It examines around one million cases of patients who were discharged after an inpatient hospital stay in 2022. The researchers also used selected data from 2019 for comparison. They looked at treatments in surgery and internal medicine as well as selected orthopedic and neurological services.
The analysis shows that many patients seek treatment outside their canton of residence. Depending on the region, this proportion is over 25 % and reaches almost 100 % in some areas. The choice of treatment location depends on several factors. In addition to geographical and topographical conditions, language and the urgency of medical treatment also play a role.
For basic care services such as minor emergencies or simple procedures, treatment outside the canton is particularly common in border regions. In the case of planned and specialised procedures, such as certain orthopadic operations, many patients specifically choose hospitals outside their home canton, even if these are further away. They often accept longer journeys, regardless of whether the treatment is complex or less complicated.
The SPLG follows purely a medical logic. However, the urgency and complexity of a service are also decisive factors in hospital planning. For example, in the case of less urgent but complex services, quick accessibility is less important. For this reason, the case data in the study were grouped according to medical urgency and treatment complexity using cluster analyses and assigned to five geographical planning levels
Within individual SPLGs, there is sometimes a high degree of heterogeneity among patients in terms of complexity and urgency. While the service group for knee prostheses, for example, comprises relatively similar treatment cases, the so-called basic package combines very different medical constellations. This diversity makes uniform planning difficult, as measures to ensure access, quality and costs may vary depending on the patient group.
Analysis of service mandates reveals overlaps between cantonal care structures. In many cantons, a small number of hospitals provide the majority of services within a service group. In addition, it is clear that a number of service mandates with very low case numbers are used by hospitals. This indicates greater potential for coordination between the cantons
A stakeholder dialogue with actors in the healthcare system showed that patient migration is influenced by geographical, topographical, linguistic and medical factors. These aspects should be systematically taken into account in planning.
The participants also emphasised the need for clearly defined national health objectives. Cantons should set strategic framework conditions, for example through cross-sectoral needs analyses, while leaving service providers sufficient autonomy for their own transformation processes.
The study formulates several ideas for the further development of planning:
Furthermore, care should not be considered solely in terms of inpatient services. Care needs must be analysed across sectors, i.e. jointly for inpatient and outpatient services. Only in this way can future care planning be realised.
The study “The Future of Swiss Hospital Capacity Planning“ is available for download online.
Image: Adobe Stock / Comugnero Silvana
