A Swiss paradox? Higher income inequality of municipalities is associated with lower mortality in Switzerland
OBJECTIVES Swiss health care is relatively costly. In order better to understand the drivers of spending, this study analyses geographic variation in per capita consultation costs for ambulatory care. METHODS Small area and longitudinal analysis of costs of ambulatory services covered by compulsory health insurance, 2003-07. RESULTS The results show considerable geographic variation in per capita consultation costs, with higher costs in urban compared to rural areas. Areas with higher availability of care had higher costs, and residents of urban and high income areas used more specialist care and generated higher costs than residents of rural areas. CONCLUSIONS There are persistent regional differences in the per capita cost of ambulatory care that are not explained by demographic factors, access to care, or needs. It is likely that higher access to care leads to greater inappropriate use, particularly of specialists. Implementing gatekeeping systems and financial incentives that encourage better coordination of primary care may slow growth in costs and improve care.