Hospital service areas – a new tool for health care planning in Switzerland

We employed federal hospital discharge data to perform a patient origin study using small area analysis. Each of 605 residential regions was assigned to one of 215 hospital provider regions where the most frequent number of discharges took place. HSAs were characterized geographically, demographically, and through health utilization indices and rates that describe hospital use. We introduced novel planning variables extracted from the patient origin study and investigated relationships among health utilization indices and rates to understand patient travel patterns for hospital use. Results were visualized as maps in a geographic information system (GIS).We obtained 100 HSAs using a patient origin matrix containing over four million discharges. HSAs had diverse demographic and geographic characteristics. Urban HSAs had above average population sizes, while mountainous HSAs were scarcely populated but larger in size. We found higher localization of care in urban HSAs and in mountainous HSAs. Half of the Swiss population lives in service areas where 65% of hospital care is provided by local hospitals.Health utilization indices and rates demonstrated patient travel patterns that merit more detailed analyses in light of political, infrastructural and developmental determinants. HSAs and health utilization indices provide valuable information for health care planning. They will be used to study variation phenomena in Swiss health care.Switzerland hosts the second most expensive health care system worldwide with health care expenditures accounting for approximately 6.2% of the GDP in 2001 [1]. In the same year overall cost of in-patient care reached 13.9 billion € with an average of 5800 € per case [2]. In order to curb costs, novel approaches to health care planning need to be assessed. We therefore investigated utilization patterns of hospitals and created population-based hospital service areas (HSAs). Such service areas take into account patient travel patterns and de