Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis

Jacques Spycher, Kevin Morisod, Karine Moschetti, Marie Annick Le Pogam, Isabelle Peytremann-Bridevaux, Patrick Bodenmann, Richard Cookson, Victor Rodwin, Joachim Marti

Research output: Contribution to journalArticlepeer-review


The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 – 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap.

Original languageEnglish (US)
Article number104948
JournalHealth policy
StatePublished - Jan 2024


  • Equity in access to community based ambulatory care
  • Potentially avoidable hospitalizations
  • Socioeconomic deprivation
  • Socioeconomic gradient

ASJC Scopus subject areas

  • Health Policy


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