Objective: To assess the importance of hospital transfers between
Swiss cantons and the factors associated with them.
Methods: Hospital discharge data, mean number of hospitals, hospital
beds and corresponding density per 100.000 inhabitants for period
1998-2008 were provided by the Federal Office of Statistics. Inclusion
criteria were: >=18 years; transferred from one hospital to another and
living in a canton different from the one they were transferred to.
Cumulative data for the study period was used.
Results: Between 1998 and 2008, 247.355 hospital transfers occurred
between cantons, representing 17.7% of all hospital transfers. This value
ranged between 2.7% (Geneva) and 81.6% (Appenzell Innerrhoden).
The main diagnoses were: circulatory system (20.1%); musculoskeletal
system (9.3%); mental and behavioural disorders (6.5%); oncology
(4.6%) and repertories diseases (2.6%). Factors influencing health
status (28.7%) and injuries and external causes (12%) were not
included in the analysis. Cantons with a university hospital received
more patients than they transferred to other cantons. The other cantons
were either "senders" or "receivers" according to the disease
considered. German-speaking cantons transferred patients more easily
than the others. Most transfers were made between geographically or
linguistically close cantons. The number of patients received was
associated with the number of hospitals (r = 0.82, p <0.001) or beds
(r = 0.85, p <0.001)in the canton; bed density (r = 0.51, p <0.01),
but not with hospital density(r = 0.08, p <0.7).
Conclusions: in Switzerland, over one-sixth of hospital transfers occur
between cantons. Several cantons are dependent of others for the
treatment of specific diseases. Cantons with a university hospital attract
more patients, suggesting an optimisation of health resources.