Explaining regional variations in health care utilization between Swiss cantons using panel econometric models

Based on the literature, relevant factors that cause geographic disparities of quantities and costs in western health care systems are identified. Using a selected set of these factors, individual panel econometric models are calculated to explain the variation of the utilization in each of the six largest health care service groups (general practitioners, specialist doctors, hospital inpatient, hospital outpatient, medication, and nursing homes) in Swiss mandatory health insurance (MHI). The main data source is 'Datenpool santésuisse', a database of Swiss health insurers.For all six health care service groups, significant factors influencing the utilization frequency over time and across cantons are found. A greater supply of service providers tends to have strong interrelations with per capita consumption of MHI services. On the demand side, older populations and higher population densities represent the clearest driving factors.Strategies to contain consumption and costs in health care should include several elements. In the federalist Swiss system, the structure of regional health care supply seems to generate significant effects. However, the extent of driving factors on the demand side (e.g., social deprivation) or financing instruments (e.g., high deductibles) should also be considered.Switzerland is a small, western European country with a population in 2009 of 7.8 million persons who live on a total area of 41,000 km2. The country consists of 26 cantons, which differ thoroughly in terms of area, number of inhabitants, population density, socio-economic situation, and language (see Figure 1).1) See acronyms, full cantonal names, and more cantonal characteristics in Appendix, Table 4.The responsibility of government is divided into three state levels: the central government (i.e., 'confederation'), the 26 cantons, and approximately 2,600 municipalities. The three levels also intervene in the Swiss health care system, which is normally characterized as a 'syst