Subelack, Jonas
Wo king Pape
Swiss hospi al inancing wi h DRGs: A e he e ea men s/-
combina ions ha a e associa ed wi h p o i abili y?
Wo king Pape Se ies in Heal h Economics, Managemen and Policy, No. 2025-02
P o ided in Coope a ion wi h:
Uni e si y o S .Gallen, School o Medicine, Chai o Heal h Economics, Policy and Managemen
Sugges ed Ci a ion: Subelack, Jonas (2025) : Swiss hospi al inancing wi h DRGs: A e he e
ea men s/- combina ions ha a e associa ed wi h p o i abili y?, Wo king Pape Se ies in Heal h
Economics, Managemen and Policy, No. 2025-02, Uni e si y o S .Gallen, School o Medicine, Chai
o Heal h Economics, Policy and Managemen , S .Gallen
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Wo king Pape Se ies in Heal h Economics, Managemen and Policy
2025 – N . 02
2025
Swiss hospi al inancing wi h DRGs: A e he e ea men s/-
combina ions ha a e associa ed wi h p o i abili y?
Jonas Subelack
I
Wo king Pape Se ies in Heal h Economics, Managemen and Policy
Edi o
P o . D . Alexande Geissle
P o esso
Chai o Heal h Economics, Policy, and Managemen
School o Medicine
Uni e si y o S .Gallen
Edi o ial o ice
Jonas Subelack
Resea ch assis an
Chai o Heal h Economics, Policy, and Managemen
School o Medicine
Uni e si y o S .Gallen
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© 2025. This publica ion is licensed by he CC license CC-BY-NC-ND 4.0
II
Swiss hospi al inancing wi h DRGs: A e he e ea men s/-combina ions
ha a e associa ed wi h p o i abili y?
Keywo ds: Hospi al inancing, hospi al p o i abili y, hospi al eimbu semen , DRG, Swi ze land
JEL Classi ica ion: H51, I11, I15, I18, L51
Au ho :
Jonas Subelack
Resea ch assis an
Chai o Heal h Economics, Policy, and Managemen , School o Medicine, Uni e si y o S .Gallen
[email p o ec ed]
Recommended ci a ion:
Subelack, Jonas (2025): Swiss hospi al inancing wi h DRGs: A e he e ea men s/-combina ions ha a e
associa ed wi h p o i abili y? Wo king Pape Se ies in Heal h Economics, Managemen and Policy, No. 2025-
02, Uni e si y o S .Gallen, School o Medicine, Chai o Heal h Economics, Policy and Managemen , S .Gallen.
1
Swiss hospi al inancing wi h DRGs: A e he e ea men s/
-combina ions ha a e associa ed wi h p o i abili y?
Jonas Subelack; Uni e si y o S .Gallen, School o Medicine
Keywo ds: Hospi al inancing, hospi al p o i abili y, hospi al eimbu semen , DRG,
Swi ze land
JEL: H51, I11, I15, I18, L51
Decla a ions
Acknowledgemen s
I wan o hank Alexande Geissle o inspi ing he esea ch ques ion. Fu he mo e, I wan o
hank Da id Ehlig and Jus us Vogel o ecommending he Ap io i algo i hm o add ess he
second esea ch ques ion. Also, I wan o hank Cha lo e Schneide and Da ia Bukano a-
Be end o hei aluable suppo in assigning hospi al cases o speci ic SPLGs. Finally, I wan
o hank he Zu ich Depa men o Heal h o p o iding he SPLG G oupe .
Funding
This esea ch did no ecei e any speci ic g an om unding agencies in he public,
comme cial, o no - o -p o i sec o s.
Con lic o in e es
None.
E hics app o al and consen o pa icipa e
No applicable.
Da a a ailabili y
The i s da ase (“Kennzahlen de Schweize Spi äle “) is publicly a ailable on he websi e o
he Swiss Fede al O ice o Public Heal h. The second da ase (“Medizinische S a is ik de
K ankenhäuse “) is a ailable upon easonable eques om he Swiss Fede al S a is ical
O ice.
2
Abs ac
Objec i e: This s udy aims o in es iga e whe he speci ic ea men s o combina ions o
ea men s a e signi ican ly associa ed wi h he p o i abili y o Swiss acu e-ca e hospi als
unde he cu en diagnosis- ela ed g oup (S-DRG) eimbu semen sys em, while accoun ing
o di e ences be ween public and p i a e ins i u ions.
Me hods: A comp ehensi e panel da ase o 142 Swiss acu e-ca e hospi als, spanning om
2015 o 2022, was u ilized, combining de ailed inancial and clinical case-le el da a.
P o i abili y was assessed h ough hospi al-le el ne inancial esul s excluding de ici -
co e ing paymen s. All cases we e assigned uniquely o a medically homogeneous se ice
g oup o a ea, as de e mined by Swiss hospi al capaci y planning. Fixed-e ec s panel
eg ession models analyzed he associa ions be ween se ice a eas and p o i abili y, while an
Ap io i associa ion ule mining algo i hm iden i ied se ice g oup combina ions associa ed
wi h p o i abili y.
Resul s: F om 2015 o 2022, o e all hospi al p o i abili y ma gins declined con inuously, wi h
public hospi als consis en ly epo ing lowe p o i abili y han p i a e hospi als (ne
p o i abili y ma gin: 0.75% s. 1.61%), despi e ecei ing subs an ial subsidies (CHF 67.1
million s. CHF 4.1 million). The p ima y panel eg ession e ealed ha h ee se ice a eas
a e signi ican ly associa ed wi h hospi al p o i abili y: Ea , nose and h oa (16,778 CHF;
p<0.05), gynecology (27,456 CHF; p<0.01), and hea (10,725 CHF; p<0.01). The Ap io i
algo i hm iden i ied ha he combina ion o he ollowing se ice g oups is mos s ongly
linked o p o i abili y: AUG1.2 (o bi , eyelids, ea duc s), BEW10 (plexus su ge y), and GEF2
(in e en ional and endo ascula ascula medicine; suppo : 0.051, con idence: 0.935, li :
1.615).
Conclusion: The analysis o hospi al p o i abili y based on he ea men s and combina ions
o ea men s pe o med indica es ha he S-DRG eimbu semen sys em is ela i ely ai .
Howe e , ac oss all analyses, he hea se ice a ea is p ima ily associa ed wi h p o i abili y,
while he se ious inju y se ice a ea is mainly associa ed wi h losses. The e o e, mino
adjus men s o he S-DRG cos weigh s should be made o educe his imbalance.
3
Abb e ia ions
CHF
Swiss anc
CHOP
Swiss classi ica ion o su gical in e en ions
CMI
Case mix index
DRG
Diagnosis ela ed g oups
EBITDA
Ea nings be o e in e es , axes, dep ecia ion and amo iza ion
FTE
Full- ime equi alen
GDP
G oss domes ic p oduc
H+
Associa ion o Swiss hospi als
ICD
In e na ional s a is ical classi ica ion o diseases and ela ed heal h p oblems
p.a.
Pe yea (pe annum)
S-DRG
Swiss diagnosis ela ed g oups
SPLB
Hospi al planning se ice a eas (DE: Spi alplanungs-Leis ungsbe eiche)
SPLG
Hospi al planning se ice g oups (DE: Spi alplanungs-Leis ungsg uppen)
VIF
Va iance in la ion ac o
4
Table o igu es
Figu e 1: Hospi al selec ion o analyses ........................................................................................... 9
Figu e 2: Hospi al ne p o i abili y ma gin om 2015 o 2022, s a i ied by public/ p i a e
hospi al .................................................................................................................................................. 13
Figu e 3: Fixed e ec s panel eg ession coe icien s ...................................................................... 14
Figu e 4: SPLG ne wo k diag am ..................................................................................................... 16
Figu e 5: Dis ibu ion o ins i u ions and cases pe legal en i y o m ......................................... 28
Figu e 6: Hospi al ne p o i abili y ma gin om 2015 o 2022 ..................................................... 28
Figu e 7: Fixed e ec s panel eg ession coe icien s (incl. ansplan s) ...................................... 29
Figu e 8: SPLG ne wo k diag am o p i a e hospi als ................................................................. 29
Figu e 9: SPLG ne wo k diag am o public hospi als .................................................................. 30
Figu e 10: SPLG combina ions linked wi h p o i abili y ............................................................... 30
Figu e 11: SPLG combina ions linked wi h p o i abili y o p i a e hospi als .......................... 31
Figu e 12: SPLG combina ions linked wi h p o i abili y o public hospi als ............................ 31
Figu e 13: SPLG combina ions linked wi h losses .......................................................................... 32
Figu e 14: SPLG combina ions linked wi h losses o public hospi als ...................................... 32
Table o ables
Table 1: Desc ip i e Swiss hospi al s a is ics om 2015 o 2022 .................................................. 11
Table 2: Fixed-e ec s panel eg ession analysis o absolu e hospi al p o i abili y (CHF) wi h
clus e - obus s anda d e o s ........................................................................................................... 15
Table 3: Typical SPLG combina ions ................................................................................................ 18
Table 4: SPLG combina ions linked wi h p o i abili y ................................................................... 19
Table 5: SPLG combina ions linked wi h losses ............................................................................. 20
Table 6: Fixed-e ec s panel eg ession analysis o ela i e hospi al p o i abili y ma gin wi h
clus e - obus s anda d e o s ........................................................................................................... 33
Table 7: Typical SPLG combina ions o p i a e hospi als ........................................................... 34
Table 8: Typical SPLG combina ions o public hospi als ............................................................. 35
Table 9: SPLG combina ions linked wi h p o i abili y o p i a e hospi als .............................. 36
Table 10: SPLG combina ions linked wi h p o i abili y o public hospi als ............................. 37
Table 11: SPLG combina ions linked wi h losses ........................................................................... 38
Table 12: SPLG combina ions linked wi h losses o public hospi als ........................................ 39
5
In oduc ion
Swiss heal hca e cos s ose con inuously o e he las decades, om 7.3% o he GDP in 1990
o 9.1% in 2000 and o 11.7% in 2022 (1). Hospi als a e he la ges cos ac o in he Swiss
heal hca e sys em, accoun ing o 35.7% o all cos s in 2022 (2). Al eady in 2007, he Swiss
go e nmen ag eed on se e al ini ia i es o con ain u he cos inc eases h ough economic
incen i es, o which mos we e olled ou in 2012 (3). The key measu es included he
implemen a ion o Swiss diagnosis- ela ed g oup eimbu semen s (S-DRG) o hospi als,
hospi al capaci y planning, dual inancing o hospi als om insu ances and can ons ( ede al
s a es), and Swiss-wide ee hospi al selec ion o pa ien s (4). The absolu e eimbu semen o
an inpa ien case in a Swiss hospi al is gene ally based on a uni o m cos weigh pe S-DRG,
mul iplied by he base a e o he indi idual hospi al (and insu ance company) (5, 6). The cos
weigh o he S-DRG e lec s he a e age esou ce consump ion o a case, calcula ed based on
his o ical da a om all Swiss hospi als (7). The base weigh a ies g ea ly be ween hospi als,
anging om CHF 8,426 a Diaconis Pallia i e Ca e Hospi al (cos weigh 1.0) o CHF 15,360
a Hochgebi gsklinik Da os in 2023 (8).
Today, a g owing numbe o Swiss hospi als a e in inancial dis ess, and 90% o Swiss
hospi als a e ope a ing conside ably below he a ge EBITDA ma gin o 10%, which is
conside ed sus ainable, allowing hospi als o inance long- e m in es men s (9-12). In 2023,
he median EBITDA ma gin o (acu e-ca e) hospi als was 2.5% (6.2% in 2021), and 25% o he
Swiss hospi als epo ed an EBITDA ma gin o less han 0.1% (12). On he one hand, H+ ( he
associa ion o Swiss hospi als) a gues ha he Swiss hospi al sys em is gene ally unde unded,
so he cu en eimbu semen sys em does no accu a ely e lec he ac ual cos inc eases (9).
On he o he hand, he ques ion a ises as o why some hospi als manage o ope a e p o i ably
on an ongoing basis, such as Klinik Hi slanden AG, wi h a e age ne p o i s o CHF 30,599,045
p.a. om 2015 o 2022 (13). In gene al, hospi als ha ope a e mo e e icien ly should make a
p o i wi hin he S-DRG sys em, bu se e al oices om medical doc o s o hospi al manage s
poin ou ha some ea men s a e mo e inancially luc a i e han o he s (10, 14-17). Fo
example, hospi al ea men s o child en we e desc ibed as unp o i able (16), while
o hopedic ea men s we e desc ibed as qui e p o i able (14, 15). I his is ue and some
ea men s gene ally gene a e highe ma gins han o he s, hospi als would achie e unequal
12
Rheuma ology
33,276
0.3%
13,276
0.3%
16,246
0.3%
Se e e inju ies
22,629
0.2%
7,461
0.2%
12,636
0.2%
Su gical musculoskele al
sys em
1,478,664
14.2%
854,397
18.8%
371,177
14.2%
Tho acic su ge y
22,725
0.2%
7,942
0.2%
13,566
0.2%
T ansplan s
4,463
0.0%
685
0.0%
3,648
0.0%
U ology
477,075
4.6%
235,846
5.2%
181,976
4.6%
Vascula
155,265
1.5%
65,877
1.5%
77,688
1.5%
Visce al su ge y
181,316
1.7%
88,059
1.9%
77,711
1.7%
No es: All hospi als a e he sum o p i a e (R1) and public (R2) hospi als as well as hospi als ope a ed by associa ions/ ounda ions
(R2) o as sole p op ie o ships (R3); a) Tes o di e ences pe o med o yea 2022 as la es yea wi h da a and mos da apoin s
ac oss yea s, b) Wilcoxon ank-sum es pe o med, since nei he no mal dis ibu ion (Shapi o-Wilk-Tes ) no a iance
homogenei y ( obus Le ene’s es ) a e gi en, c) Tes o di e ences pe o med o yea 2020 as la es yea wi h da a, d) Chi-
squa ed es , e) Excluding de ici co e age
depa u es p.a.; p<0.05), had a signi ican ly highe bed occupa ion a e (80.9% s. 70.1%;
p<0.05), included signi ican ly mo e o en an eme gency depa men (98.8% s. 60.5%; p<0.05)
and a e signi ican ly mo e o en a eaching hospi al (94.3% s. 61.0%; p<0.05). The mean
esou ce consump ion pe pa ien , as indica ed by he CMI, is qui e simila (0.974 s. 0.956; p
= 0.92). Public and p i a e hospi als signi ican ly de ia e in e ms o hospi al ype (p<0.05) wi h
mos public hospi als (48.8%) being gene al hospi als cen e ca e le el 2 (K112), and mos
p i a e hospi als (30.3%) being special clinics o su ge y (K231). Public as well as p i a e
hospi als p ima ily ea ed pa ien s om he SPLB basic package (all hospi als a e age: 48.9%),
om su gical musculoskele al sys em (14.2%), and obs e ics (7.3%). Financially, p i a e
hospi als on a e age epo ed p o i s (649,936 CHF) compa ed o public hospi als, which on
a e age epo ed signi ican losses (-2,282,343 CHF; p<0.05). Public hospi als ecei ed
signi ican ly highe subsidies han p i a e hospi als (67,055,126 CHF s. 4,103,927 CHF;
p<0.05). All hospi als gene a ed he majo i y o e enues om inpa ien ea men s (55.2% o
all hospi als’ e enues; 74.4% compa ed o ou pa ien ea men s). Public hospi als elied
signi ican ly less on inpa ien e enues han p i a e hospi als (p<0.05).
In 2015, he median hospi al p o i abili y ma gin was 1.19%, indica ing ha mos hospi als
we e p o i able; howe e , he e was also a g ea a iance, and some hospi als epo ed
subs an ial losses (see Figu e 6). Un il 2022, he median hospi al p o i abili y ma gin had
consis en ly dec eased o 0.24%, wi h a dip in 2020, whe e mos hospi als epo ed losses
(median p o i abili y ma gin: -0.96%). The a iance in hospi al p o i abili y ma gins inc eased
om 2015 o 2022. When s a i ying hospi al p o i abili y ma gins by public and p i a e
hospi als, i is e iden ha p i a e hospi als con inuously epo ed highe p o i abili y
ma gins (2015: public: 0.75% s. p i a e: 1.61%; see Figu e 2). Bo h public and p i a e hospi als
epo ed declining p o i abili y ma gins. Since 2019, public hospi als ha e epo ed a nega i e
13
median hospi al p o i abili y ma gin, whe eas p i a e hospi als epo ed a nega i e median
hospi al p o i abili y ma gin only once in 2020. The a iance in he hospi al p o i abili y
ma gins is g ea e o p i a e han o public hospi als.
Figu e 2: Hospi al ne p o i abili y ma gin om 2015 o 2022, s a i ied by public/ p i a e hospi al
No e: Ma gin (%) e e ing o ne p o i ma gin(excluding de ici co e age) di ided by hospi al e enue; The whiske s in he
boxplo s ep esen alues wi hin 1.5 imes he in e qua ile ange (IQR), ex ending om he i s qua ile (Q1) o he hi d qua ile
(Q3). Values ou side his ange (po en ial ou lie s) a e excluded om he isualiza ion.
Table 2 and Figu e 3 p esen he esul s o he ixed-e ec s panel eg ession analysis wi h
clus e - obus s anda d e o s. When ocusing on all hospi als and he absolu e numbe o
cases ea ed pe SPLB, h ee signi ican SPLBs a e iden i ied, all o which a e posi i ely
associa ed wi h hospi al p o i abili y: Ea , nose and h oa (16,778 CHF; p<0.05), gynecology
(27,456 CHF; p<0.01), and hea (10,725 CHF; p<0.01). Co espondingly, i can be in e ed ha
an addi ional pa ien ea ed in he SPLB hea is associa ed wi h an a e age inc ease in annual
hospi al p o i o a ound 10,725 CHF, ce e is pa ibus. The la ges coe icien s, albei no
signi ican , a e neph ology (60,419 CHF) on he posi i e side and ansplan s (-182,811 CHF)
on he opposing side. Fo p i a e and public hospi als, he SPLB hea is also signi ican ly
posi i ely associa ed in bo h subg oups (p i a e: 3,775 CHF, p<0.05; public: 18,379 CHF,
p<0.05). Gynecology is only signi ican ly posi i ely associa ed a public hospi als (43,541 CHF;
p<0.01). Ea , nose and h oa is no signi ican in any o he subg oups. P i a e hospi als also
epo h ee signi ican ly nega i e associa ed SPLBs wi h hospi al p o i abili y: neu osu ge y
(-43,505 CHF; p<0.05), se e e inju ies (-106,727 CHF; p<0.05), and ansplan s (-542,132 CHF; p<0.01).
14
Figu e 3: Fixed e ec s panel eg ession coe icien s
No e: Values indica e coe icien in CHF pe addi ional case, wi h posi i e alues indica ing inc easing p o i abili y; excluding
SPLB ansplan s because o ex ao dina ily high a iance. Figu e 7 includes all SPLB coe icien s, including ansplan s.
When examining all hospi als and analyzing he bina y indica ion o whe he a SPLB was
ea ed, h ee SPLBs we e signi ican ly associa ed wi h p o i abili y: opening an SPLB uni in
su gical musculoskele al sys em (-2,626,690 CHF; p<0.05) o ansplan s (-5,194,664 CHF;
p<0.01) esul ed in a signi ican loss. Opening an SPLB uni in isce al su ge y (1,798,277 CHF;
p<0.05) led o a signi ican inc ease in p o i abili y. Su gical musculoskele al sys em (-2,097,084
CHF; p<0.05) and isce al su ge y (1,891,208 CHF; p<0.01) we e simila ly signi ican ly
associa ed in p i a e hospi als. T ansplan s could no be analyzed o any subg oup due o
collinea i y. Addi ionally, ea , nose, and h oa (-14,700,000 CHF; p < 0.01), endoc inology
(5,545,300 CHF; p < 0.05), and gynecology (-11,300,000 CHF; p < 0.05) ecei ed s a is ically
signi ican esul s o public hospi als. A obus ness check wi h a simila eg ession, using
p o i abili y ma gin as he dependen a iable ins ead o absolu e p o i , yielded di ec ionally
simila esul s (see Table 6). Speci ically, hea , ea , nose and h oa , gynecology, and isce al
su ge y a e also pa ially signi ican ly associa ed wi h he hospi al's p o i abili y ma gin.
The Ap io i-based ne wo k analysis e ealed dis inc pa e ns o associa ions among he
SPLGs. The SPLG BP (basic package su ge y and in e nal medicine) eme ged as a cen al and
in e connec ed hub, equen ly co-occu ing wi h nume ous o he SPLGs (see Figu e 4).
Basic package
De ma ology, Hema ology, Radio oncology
Ea , nose and h oa
Endoc inology
Gas oen e ology
Gynecology
Hea
Neph ology
Neu ology
Neu osu ge y
Obs e ics
Oph halmology
Pneumology
Rheuma ology
Se e e inju ies
Su gical musculoskele al sys em
Tho acic su ge y
U ology
Vascula
Visce al su ge y
-200000 -100000 0 100000 200000
15
Table 2: Fixed-e ec s panel eg ession analysis o absolu e hospi al p o i abili y (CHF) wi h clus e - obus s anda d e o s
No e: a) The SPLBs De ma ology, Hema ology, and Radio oncology we e me ged in o he combined ca ego y De ma ology/Hema ology/Radio oncology. This was necessa y because he h ee SPLBs
exhibi ed e y high co ela ions, leading o p oblema ic mul icollinea i y (Va iance In la ion Fac o : VIF > 10). By me ging he mos s ongly co ela ed SPLBs, he mul icollinea i y was educed o
accep able le els (VIF < 10), ul illing he s a is ical equi emen s o he analysis. b) The independen a iables a e bina y, wi h “1” indica ing ha a hospi al is ele an wi hin he SPLG and “0“ indica ing
no ele an . A hospi al was classi ied as ele an i i was among he p o ide s ha collec i ely ea ed a leas 97.5% o all cases wi hin each SPLG, excluding p o ide s wi h only minimal caseloads. I
one SPLG was classi ied as ele an , he SPLB was conside ed ele an . c) „n.a.“ e e ing o independen a iables ha STATA has omi ed because o collinea i y. Hausman es s we e pe o med o
jus i y he selec ion o ixed-e ec s models o e andom-e ec s models, indica ing signi ican unobse ed he e ogenei y a he hospi al le el. Addi ionally, modi ied Wald es s o g oupwise
he e oscedas ici y, Woold idge es s o au oco ela ion, and Pesa an’s es s o c oss-sec ional dependence we e conduc ed. Due o e idence o he e oscedas ici y, au oco ela ion, and po en ial c oss-
sec ional dependence, ixed-e ec s panel eg essions wi h clus e - obus s anda d e o s a he hospi al le el we e applied o ensu e obus and unbiased es ima es.
All hospi als
P i a e hospi als
Public hospi als
Independen a iables:
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
SPLB
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Basic package
788 (1,294)
n.a.c
2,104 (1,168) *
n.a.c
-1,094 (2,825)
n.a.c
De ma ology/ Hema ology/
Radio oncologya
-12,980 (14,425)
-748,615 (510,610)
-2,582 (7,830)
-933,174 (538,342) *
-12,748 (25,811)
16,300,000 (10,300,000)
Ea , nose and h oa
16,778 (8,218) **
-1,548,084 (1,026,655)
4,835 (2,954)
-234,887 (764,646)
49,512 (25,091) *
-14,700,000 (3,211,939) ***
Endoc inology
-1,997 (18,515)
318,924 (425,556)
-1,902 (27,201)
-91,198 (651,719)
-13,369 (28,427)
5,535,300 (2,586,260) **
Gas oen e ology
13,030 (13,103)
-985,998 (940,816)
4,352 (12,457)
1,108,777 (902,719)
10,114 (26,507)
-12,100,000 (9,493,829)
Gynecology
27,456 (9,234) ***
-1,363,788 (703,839) *
13,745 (9,981)
-767,032 (689,799)
43,541 (14,305) ***
-11,300,000 (5,189,834) **
Hea
10,725 (3,990) ***
1,057,310 (918,382)
3,775 (1,616) **
664,512 (1,110,258)
18,379 (7,411) **
6,591,464 (5,691,931)
Neph ology
60,419 (41,184)
-612,451 (998,626)
57,625 (59,098)
-142,286 (912,539)
71,539 (58,649)
-144,040 (2,118,296)
Neu ology
15 (13,060)
174,037 (493,022)
9,972 (15,996)
-30,954 (489,105)
-2,833 (21,268)
8,014,518 (14,500,000)
Neu osu ge y
-10,838 (25,518)
55,838 (638,017)
-43,505 (19,935) **
720,206 (688,105)
82,888 (72,053)
-2,135,011 (2,727,181)
Obs e ics
4,382 (6,046)
-107,049 (2,681,923)
347 (5,705)
1,430,144 (3,019,629)
14,517 (23,306)
n.a.c
Oph halmology
-23,418 (29,204)
260,918 (646,473)
-617 (10,036)
-906,898 (825,231)
-67,780 (76,814)
808,042 (1,888,360)
Pneumology
5,725 (10,899)
-632,549 (631,180)
7,864 (6,335)
155,823 (612,505)
-13,049 (23,948)
-2,320,190 (5,290,946)
Rheuma ology
-6,576 (42,203)
12,993 (522,067)
4,009 (39,187)
248,123 (615,220)
-13,642 (112,442)
-2,560,479 (8,677,581)
Se e e inju ies
-82,661 (44,188) *
59,808 (516,380)
-106,727 (51,298) **
-15,608 (630,606)
-88,934 (148,476)
-4,475,578 (2,905,232)
Su gical musculoskele al
sys em
1,503 (1,769)
-2,626,690 (1,112,054) **
3,944 (2,070) *
-2,097,084 (978,876) **
-5,453 (6,074)
n.a.c
Tho acic su ge y
-40,366 (59,168)
1,356,002 (863,067)
40,532 (36,045)
1,898,662 (1,099,069) *
-118,473 (119,616)
5,551,185 (2,829,515) *
T ansplan s
-182,811 (153,026)
-5,194,664 (1,175,394) ***
-542,132 (92,453) ***
n.a.c
-125,061 (170,870)
n.a.c
U ology
10,601 (6,113) *
314,817 (1,331,917)
2,288 (5,601)
-24,311 (961,959)
13,596 (14,624)
n.a.c
Vascula
-26,870 (14,092) *
-484,036 (926,321)
-17,713 (8,955) *
-1,329,890 (968,516)
-35,692 (30,204)
1,570,279 (2,757,239)
Visce al su ge y
-16,942 (12,206)
1,798,277 (748,464) **
-13,064 (13,223)
1,891,208 (714,574) ***
-26,518 (18,771)
7,894,242 (7,576,948)
Con ounde s: Yea , bed occupancy a e, sha e o p i a e pa ien s, sha e o inpa ien e enue ***) p<0.01; **) p<0.05; *) p<0.1
16
Figu e 4: SPLG ne wo k diag am
No e: SPLG ne wo k diag am based on he op 100 ules wi h he highes li .
17
Despi e i s cen al posi ion and nume ous connec ions, he s eng h o hese associa ions (li )
is low o mode a e. In con as , he pe iphe al nodes o med se e al specialized and closely
connec ed clus e s, especially a ound he SPLGs BEW.x (SPLB: Su gical musculoskele al
sys em), VIS.x (SPLB: Visce al su ge y), and URO.x (SPLB: U ology). Table 3 no es he
undamen al ules. He e, he ule wi h he g ea es li (2.907) had he wo SPLGs URO1.1
(u ology wi h specializa ion in 'ope a i e u ology') and VIS1.4.1 (complex ba ia ic su ge y)
as an eceden s o VIS1.4 (ba ia ic su ge y) as consequen . The ule wi h he g ea es li
(2.266) and wo an eceden s om di e en SPLGs han he consequen is GEB1 (basic
obs e ics ca e) and URO1.1.4 (isola ed ad enalec omy) as an eceden s o HNO2 ( hy oid and
pa a hy oid su ge y) as consequen . When examining he ne wo k analysis o he p i a e
hospi als (see Figu e 8 and Table 7), he SPLG BP also appea s as a cen al and highly
connec ed ne wo ked hub wi h low o mode a e li s. A e y dominan clus e wi h s ong
con idence and li s o he BEW.x SPLGs is e iden . Fu he , a mo e in e connec ed clus e
wi h GAE.x (SPLB: Gas oen e ology) and VIS.x SPLGs is isible. The ule wi h he g ea es
li (2.488) had he wo SPLGs KAR1 (ca diology including pacemake ) and NEU1 (neu ology)
as an eceden s o GAE1.1 (specialized gas oen e ology) as consequen . When examining he
ne wo k analysis o public hospi als (see Figu e 9, Table 8), i e eals a dis inc s uc u e
wi hou a clea cen e . One s ong clus e is isible a ound HAE1.1 (highly agg essi e
lymphomas and acu e leukemias), and se e al o he , mo e in e connec ed clus e s a e isible
a ound BEW7.2.1 (knee p os hesis eplacemen ope a ions) and URO1.1.7 (implan a ion o an
a i icial u ina y bladde sphinc e ). The ule wi h he g ea es li (3.280) had he wo SPLGs
AUG1.4 (ca a ac ) and VIS1.2 (li e esec ion) as an eceden s o AUG1.5 ( i eous humo /
e inal p oblems) as consequen . The ule wi h he g ea es li (3.114) and wo an eceden s
om di e en SPLGs han he consequen is NCH1.1 (specialized neu osu ge y) and GYNT
(gynecological umo s) as an eceden s o GEFA (in e en ions and ascula su ge y in a-
abdominal essels) as consequen .
Fu he , he Ap io i algo i hm iden i ied SPLG combina ions ha a e linked wi h p o i abili y.
Fo all hospi als, he SPLGs ha a e mos s ongly linked wi h p o i abili y (suppo : 0.051,
con idence: 0.935, li : 1.615) a e AUG1.2 (o bi , eyelids, ea duc s), BEW10 (plexus su ge y), and
GEF2 (in e en ional and endo ascula ascula medicine) (see Table 4). On an agg ega ed
le el, di e se combina ions o he SPLGs AUG1.2 and BEW10 o AUG1.2 and VIS1.2 o
BEW10 and HNO1.3 (middle ea su ge y) a e associa ed wi h p o i abili y (see Figu e 10).
18
Table 3: Typical SPLG combina ions
An eceden s
Consequen
Suppo
Con idence
Li
URO1.1, VIS1.4.1
VIS1.4
0.255
0.993
2.907
GAE1, VIS1.4.1
VIS1.4
0.259
0.986
2.888
PNE1, VIS1.4.1
VIS1.4
0.252
0.986
2.887
GYN1, VIS1.4.1
VIS1.4
0.258
0.983
2.878
DER1, VIS1.4.1
VIS1.4
0.256
0.983
2.877
VIS1.4.1
VIS1.4
0.264
0.980
2.869
VIS1, VIS1.4.1
VIS1.4
0.264
0.980
2.869
URO1, VIS1.4.1
VIS1.4
0.264
0.980
2.869
BEW1, VIS1.4.1
VIS1.4
0.264
0.980
2.869
BP, VIS1.4.1
VIS1.4
0.264
0.980
2.869
BEW5, VIS1.4.1
VIS1.4
0.256
0.980
2.868
BEW2, VIS1.4.1
VIS1.4
0.256
0.980
2.868
BEW6, VIS1.4.1
VIS1.4
0.250
0.979
2.866
GEF1, HNO2
ANG1
0.253
0.979
2.830
GEF1, RAD1
ANG1
0.256
0.976
2.821
GEF1, HNO1.1
ANG1
0.254
0.966
2.792
GAE1.1, GEF1
ANG1
0.261
0.961
2.776
GEB1, GEF1
ANG1
0.273
0.957
2.764
GEF1, GYN2
ANG1
0.270
0.950
2.745
GEF1, HAE3
ANG1
0.270
0.950
2.745
GEB1, URO1.1.4
HNO2
0.254
0.963
2.266
KAR1, URO1.1.4
HNO2
0.250
0.962
2.264
RAD1, VIS1.5
HNO2
0.256
0.960
2.259
GYN2, URO1.1.4
HNO2
0.257
0.957
2.252
KAR1.1, VIS1.5
HNO2
0.257
0.957
2.252
GAE1.1, URO1.1.4
HNO2
0.256
0.957
2.252
KAR1, VIS1.5
HNO2
0.283
0.955
2.247
KAR1.1, VIS1.5
KAR1
0.262
0.974
2.235
KAR1.1, VIS1.4
KAR1
0.258
0.964
2.212
NEU2.1, VIS1.5
KAR1
0.256
0.957
2.196
RAD1, VIS1.5
KAR1
0.255
0.953
2.189
GEF1, NEU1
NEP1
0.256
0.966
2.187
KAR1.1, RAD1
KAR1
0.279
0.952
2.184
HNO2, UNF1
KAR1
0.278
0.951
2.184
HAE1, VIS1.5
KAR1
0.276
0.951
2.183
NEU3, VIS1.5
NEP1
0.282
0.955
2.161
GEF1, NEU3
NEP1
0.256
0.954
2.158
ANG1, NEU1
NEP1
0.274
0.954
2.158
NEU2.1, VIS1.5
NEP1
0.255
0.953
2.158
HNO2, UNF1
NEP1
0.278
0.951
2.153
RHE2, VIS1.5
ONK1
0.259
0.954
2.113
RAD1, VIS1.5
ONK1
0.255
0.953
2.111
BEW1, RAO1
ONK1
0.253
0.953
2.110
RAO1, VIS1
ONK1
0.252
0.953
2.110
HAE3, RAO1
ONK1
0.250
0.953
2.109
BEW7.2.1
BEW7.2
0.297
1.000
2.064
BEW7.1.1, BEW7.2.1
BEW7.2
0.258
1.000
2.064
BEW7.1, BEW7.2.1
BEW7.2
0.295
1.000
2.064
BEW6, BEW7.2.1
BEW7.2
0.296
1.000
2.064
BEW5, BEW7.2.1
BEW7.2
0.295
1.000
2.064
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 16,445 ules iden i ied
19
Table 4: SPLG combina ions linked wi h p o i abili y
An eceden s
Consequen
Suppo
Con idence
Li
AUG1.2, BEW10, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BEW7, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GEF2, HNO1.2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BEW3, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GEF2, VIS1
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GAE1, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, DER1, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GEF2, GYN1
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BEW6, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GEF2, URO1
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BEW5, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BEW2, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW1, BEW10, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, BP, GEF2
P o i abili y
0.051
0.935
1.615
AUG1.2, BEW10, GEF2, GYN1.3
P o i abili y
0.051
0.934
1.613
AUG1.2, BEW10, GEF2, HNO1.1
P o i abili y
0.051
0.934
1.613
AUG1.2, BEW10, GEF2, URO1.1
P o i abili y
0.051
0.934
1.613
AUG1.2, BEW10, GYN1.4, HNO1.2
P o i abili y
0.054
0.924
1.595
AUG1.2, BEW10, DER1, GYN1.4
P o i abili y
0.052
0.922
1.591
AUG1.2, BEW10, BEW8.1, GYN1.4
P o i abili y
0.051
0.919
1.587
AUG1.2, BEW10, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BEW7, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BEW3, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, GYN1, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BEW6, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BEW5, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BEW2, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW1, BEW10, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, BP, GYN1.4
P o i abili y
0.055
0.912
1.574
AUG1.2, BEW10, GYN1.4, GYN2
P o i abili y
0.054
0.910
1.571
AUG1.2, BEW10, GYN1.4, URO1
P o i abili y
0.054
0.910
1.571
AUG1.2, BEW10, GYN1.3, GYN1.4
P o i abili y
0.053
0.909
1.569
AUG1.2, BEW10, GYN1.4, HNO1
P o i abili y
0.053
0.909
1.569
AUG1.2, BEW10, GYN1.4, HNO1.1
P o i abili y
0.052
0.908
1.567
AUG1.2, BEW10, GYN1.4, URO1.1
P o i abili y
0.052
0.908
1.567
AUG1.2, BEW10, GAE1, GYN1.4
P o i abili y
0.052
0.908
1.567
AUG1.2, BEW10, BEW8, GYN1.4
P o i abili y
0.051
0.906
1.564
AUG1.2, BEW10, GEB1, GYN1.4
P o i abili y
0.051
0.906
1.564
AUG1.2, BEW10, GYN1.4, VIS1
P o i abili y
0.051
0.906
1.564
AUG1.2, BEW10, BEW8.1, GYN1.3
P o i abili y
0.051
0.906
1.564
AUG1.2, BEW10, BEW3, GYN1.3
P o i abili y
0.057
0.901
1.556
AUG1.2, BEW10, GYN1.3, HNO1.2
P o i abili y
0.056
0.900
1.553
AUG1.2, BEW10, GYN1.3, URO1.1
P o i abili y
0.055
0.899
1.551
AUG1.2, BEW10, GYN1.3, HNO1.1
P o i abili y
0.054
0.897
1.548
AUG1.2, BEW10, GYN1.3, PNE1
P o i abili y
0.051
0.892
1.540
GEF2, HNO1.2, KAR1.1, VIS1.2
P o i abili y
0.051
0.891
1.537
GEF2, HAE1, HNO1.2, VIS1.2
P o i abili y
0.051
0.891
1.537
AUG1.2, BEW10, BEW2, GYN1.3
P o i abili y
0.057
0.889
1.534
AUG1.2, BEW10, DER1, GYN1.3
P o i abili y
0.055
0.886
1.529
GEF2, HNO1.2, VIS1.2
P o i abili y
0.052
0.881
1.520
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 187,463 ules iden i ied
20
Fo p i a e hospi als, he SPLGs ha a e mos s ongly linked wi h p o i abili y (suppo :
0.052, con idence: 1.0, li : 1.617) a e AUG1.2 and GEF2 (see Table 9). On an agg ega ed le el,
di e se combina ions wi h he SPLGs ANG2 (in a-abdominal ascula in e en ions) and
GYN1.2 (malignan neoplasms o he ce ix), o ANG2 and GEF2, o GYN1.4 (malignan
neoplasms o he o a y) and GEF2 a e associa ed wi h p o i abili y o his subg oup (see
Figu e 11). Fo public hospi als, he SPLGs ha a e mos s ongly linked wi h p o i abili y
(suppo : 0.053, con idence: 1.0, li : 2.050) we e AUG1.3 (specialized an e io segmen
su ge y), HER1.1.3 (su ge y and in e en ions on he ho acic ao a), and URO1.1.6 (plas ic
econs uc ion o he u e h a) (see Table 10). On an agg ega ed le el, di e se combina ions
wi h he SPLGs HER1.1.3 and AUG1.3 o AUG1.3 and NCH1 (c anial neu osu ge y) o
AUG1.3 and HAE1.1 a e associa ed wi h p o i abili y o his subg oup (see Figu e 12).
Addi ionally, he Ap io i algo i hm iden i ied SPLG combina ions ha a e linked wi h losses.
Fo all hospi als, he SPLGs ha a e mos s ongly linked wi h losses (suppo : 0.054,
con idence: 0.701, li : 1.667) a e UNF1 ( auma su ge y poly auma), UNF2 (se e e bu ns),
GEFA, and BEW7.1.1 (hip p os hesis eplacemen ope a ions) (see Table 11).
Table 5: SPLG combina ions linked wi h losses
An eceden s
Consequen
Suppo
Con idence
Li
UNF1, UNF2, GEFA, BEW7.1.1
Losses
0.054
0.701
1.667
UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
UNF2, GEFA, GYNT, BEW7.1.1
Losses
0.056
0.700
1.664
UNF2, BEW7.1, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
HAE1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
NEU3, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
NEU2, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
GYN2, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
HAE3, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
GEB1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
RHE1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
HAE2, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
PNE1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
UNF2, VIS1, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
GAE1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
DER1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
GYN1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
BEW6, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
UNF2, URO1, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
BEW5, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
BEW2, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
BEW1, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
BP, UNF2, GEFA, BEW7.1.1
Losses
0.056
0.700
1.664
No e: Top ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 23 ules iden i ied
21
On an agg ega ed le el, combina ions o he wo SPLGs UNF1 and UNF2, o UNF2 and GEFA,
a e associa ed wi h losses (see Figu e 13). Fo p i a e hospi als, no ule has been iden i ied ha
links SPLGs wi h losses a he p e-de ined h esholds. Fo public hospi als, he SPLGs ha a e
mos s ongly linked wi h losses (suppo : 0.053, con idence: 0.929, li : 1.813) a e AUG1.1
(s abology), VIS1.3 (esophageal esec ion), and BEW7.1.1 (see Table 12). On an agg ega ed
le el, di e se combina ions o he SPLGs AUG1.1 and VIS1.3, o VIS1.3 and VIS1.4, o VIS1.3
and BEW10, a e associa ed wi h losses (see Figu e 14).
Discussion
This s udy aims o in es iga e whe he he e is a sys ema ic imbalance in he eimbu semen
o inpa ien hospi al cases, speci ically be ween p o i able and unp o i able se ice g oups/
a eas. In gene al, he hospi al p o i abili y esul s highligh a wo sening si ua ion, as he ne
p o i abili y o Swiss hospi als declined con inuously om 2015 o 2022, wi h many hospi als
epo ing losses. While he p o i abili y dip in 2020 can be a ibu ed o he COVID-19
pandemic, he gene al downwa d end is unambiguous (43). Acco dingly, he hospi al
p o i abili y esul s a e in line wi h he widely discussed de e io a ing inancial si ua ion o
Swiss hospi als (10, 11, 17). P i a e hospi als, which exhibi dis inc s uc u es and a e
p ima ily special y hospi als o su ge y, cons an ly epo ed highe ne p o i abili y ma gins
han public hospi als. Speci ically, hal o hese hospi als s ill epo ed a small posi i e ne
p o i in 2022, while almos 75% o public hospi als epo ed a loss, despi e ecei ing on
a e age 67,055,126 CHF in subsidies (e.g., o eaching) in addi ion o he S-DRG
eimbu semen s, which a e e lec ed in he ne p o i abili y. The inding ha public hospi als
a e inancially in a wo se si ua ion han p i a e hospi als is also in line wi h he public deba e
(15, 44).
Rega ding esea ch ques ion one, whe he he e a e signi ican posi i e o nega i e
associa ions be ween SPLBs and p o i abili y, some SPLBs ha e been iden i ied wi h
signi ican associa ions, al hough he esul s di e in pa depending on he sub-analysis. The
p ima y causal ixed e ec s panel eg ession iden i ied he ollowing SPLBs as signi ican ly
posi i ely associa ed wi h hospi al p o i abili y: hea , gynecology, and ea , nose, and h oa .
Ac oss he a ious subg oup analyses, he SPLB hea and isce al su ge y we e
p edominan ly associa ed wi h hospi al p o i abili y, and he SPLB gynecology and ea , nose
28
Appendix
Figu e 5: Dis ibu ion o ins i u ions and cases pe legal en i y o m
No e: Exempla y o he yea 2022; De ini ions om Swiss Fede al O ice o Public Heal h: P i a e o ganiza ion (R1), Associa ion/
ounda ion (R2), Sole p op ie o ship (R3), Public o ganiza ion (R4).
Figu e 6: Hospi al ne p o i abili y ma gin om 2015 o 2022
No e: Ma gin (%) e e ing o ne p o i ma gin(excluding de ici co e age) di ided by hospi al e enue; The whiske s in he
boxplo s ep esen alues wi hin 1.5 imes he in e qua ile ange (IQR), ex ending om he i s qua ile (Q1) o he hi d qua ile
(Q3). Values ou side his ange (po en ial ou lie s) a e excluded om he isualiza ion.
-10
-5
0
5
10
Ma gin (%)
2015 2016 2017 2018 2019 2020 2021 2022
excludes ou side alues
29
Figu e 7: Fixed e ec s panel eg ession coe icien s (incl. ansplan s)
Figu e 8: SPLG ne wo k diag am o p i a e hospi als
No e: SPLG ne wo k diag am based on op 100 ules based on highes li .
Basic package
De ma ology, Hema ology, Radio oncology
Ea , nose and h oa
Endoc inology
Gas oen e ology
Gynecology
Hea
Neph ology
Neu ology
Neu osu ge y
Obs e ics
Oph halmology
Pneumology
Rheuma ology
Se e e inju ies
Su gical musculoskele al sys em
Tho acic su ge y
T ansplan s
U ology
Vascula
Visce al su ge y
-600000 -400000 -200000 0 200000
30
Figu e 9: SPLG ne wo k diag am o public hospi als
No e: SPLG ne wo k diag am based on op 100 ules based on highes li .
Figu e 10: SPLG combina ions linked wi h p o i abili y
31
Figu e 11: SPLG combina ions linked wi h p o i abili y o p i a e hospi als
Figu e 12: SPLG combina ions linked wi h p o i abili y o public hospi als
32
Figu e 13: SPLG combina ions linked wi h losses
Figu e 14: SPLG combina ions linked wi h losses o public hospi als
33
Table 6: Fixed-e ec s panel eg ession analysis o ela i e hospi al p o i abili y ma gin wi h clus e - obus s anda d e o s
All hospi als
P i a e hospi als
Public hospi als
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
Absolu e SPLB
case numbe s
SPLB o e ed
by hospi alb
SPLB
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Coe icien
(S anda d E o )
P- alue
Basic package
0.001 (0.000)
n.a.c
0.001 (0.001)
n.a.c
0.000 (0.001)
n.a.c
De ma ology/ Hema ology/
Radio oncologya
-0.001 (0.003)
-2.493 (1.091) **
-0.001 (0.004)
-2.926 (1.333) **
0.001 (0.006)
7.184 (4.611)
Ea , nose and h oa
0.004 (0.001) ***
-0.186 (0.932)
0.003 (0.002) **
0.841 (0.941)
0.009 (0.006)
-7.499 (4.268) *
Endoc inology
0.005 (0.005)
0.482 (0.632)
-0.002 (0.008)
-0.827 (0.972)
0.004 (0.010)
0.768 (1.444)
Gas oen e ology
0.004 (0.004)
1.305 (0.732) *
-0.004 (0.004)
2.025 (1.061) *
0.005 (0.006)
-8.321 (3.911) **
Gynecology
0.004 (0.002) *
-0.597 (0.776)
0.006 (0.005)
-0.244 (1.161)
0.010 (0.005) **
-2.841 (1.402) *
Hea
0.001 (0.001) **
0.739 (0.658)
0.001 (0.001)
0.239 (0.882)
0.001 (0.001)
1.015 (1.818)
Neph ology
-0.009 (0.009)
-0.152 (1.389)
0.006 (0.018)
0.419 (0.855)
-0.019 (0.017)
-1.819 (5.096)
Neu ology
0.000 (0.003)
0.060 (0.737)
0.006 (0.006)
-0.204 (1.129)
-0.004 (0.004)
31.886 (9.087) ***
Neu osu ge y
0.002 (0.006)
0.305 (0.343)
-0.003 (0.008)
0.563 (0.459)
0.018 (0.015)
0.788 (1.479)
Obs e ics
0.001 (0.002)
-1.565 (1.747)
0.000 (0.003)
-1.212 (2.174)
0.003 (0.006)
n.a.c
Oph halmology
-0.001 (0.006)
0.391 (0.545)
0.001 (0.007)
-0.469 (0.911)
-0.009 (0.013)
0.953 (0.884)
Pneumology
-0.004 (0.003)
0.402 (0.769)
0.000 (0.002)
0.808 (1.157)
-0.015 (0.009)
-5.929 (1.943) ***
Rheuma ology
0.000 (0.011)
-0.235 (0.754)
0.001 (0.014)
0.656 (1.068)
-0.012 (0.025)
-16.103 (4.675) ***
Se e e inju ies
-0.008 (0.010)
0.360 (0.555)
-0.024 (0.016)
0.666 (0.745)
0.010 (0.024)
-2.151 (1.384)
Su gical musculoskele al sys em
0.001 (0.001)
-0.610 (0.966)
0.001 (0.001)
-0.743 (1.624)
0.003 (0.003)
n.a.c
Tho acic su ge y
0.000 (0.010)
0.562 (0.579)
0.005 (0.016)
1.159 (0.743)
-0.005 (0.021)
1.014 (1.052)
T ansplan s
-0.030 (0.020)
-1.249 (0.999)
-0.060 (0.052)
n.a.c
-0.041 (0.051)
n.a.c
U ology
0.000 (0.002)
2.316 (1.932)
0.000 (0.004)
2.278 (1.923)
-0.002 (0.003)
n.a.c
Vascula
-0.003 (0.003)
0.189 (0.796)
-0.008 (0.004) **
-0.760 (0.834)
0.004 (0.010)
3.668 (2.228)
Visce al su ge y
-0.006 (0.005)
2.291 (1.548)
0.002 (0.006)
3.588 (2.105) *
-0.008 (0.010)
6.857 (3.229) **
Con ounde s: Yea , bed occupancy a e, sha e o p i a e pa ien s, sha e o inpa ien e enue ***) p<0.01; **) p<0.05; *) p<0.1
No e: Coe icien p o ided in pe cen age poin s; a) The SPLBs De ma ology, Hema ology, and Radio oncology we e me ged in o he combined ca ego y De ma ology/Hema ology/Radio oncology. This
was necessa y because he h ee SPLBs exhibi ed e y high co ela ions, leading o p oblema ic mul icollinea i y (VIF > 10). By me ging he mos s ongly co ela ed SPLBs, he mul icollinea i y was
educed o accep able le els (VIF < 10), ul illing he s a is ical equi emen s o he analysis. b) The independen a iables a e bina y, wi h “1” indica ing ha a hospi al is ele an wi hin he SPLG and
“0“ indica ing no ele an . A hospi al was classi ied as ele an i i was among he p o ide s ha collec i ely ea ed a leas 97.5% o all cases wi hin each SPLG, excluding p o ide s wi h only minimal
caseloads. I one SPLG was classi ied as ele an , he SPLB was conside ed ele an . c) „n.a.“ e e ing o independen a iables ha STATA has omi ed because o collinea i y.
34
Table 7: Typical SPLG combina ions o p i a e hospi als
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 8,416 ules iden i ied.
An eceden s
Consequen
Suppo
Con idence
Li
KAR1, NEU1
GAE1.1
0.280
0.964
2.488
KAR1, NEU3
GAE1.1
0.279
0.959
2.475
KAR1, NEU2.1
GAE1.1
0.253
0.955
2.465
DER1, VIS1.5
GAE1.1
0.259
0.951
2.454
KAR1.1, NEU1
NEU3
0.268
0.989
2.141
KAR1, NEU1
NEU3
0.286
0.985
2.131
NEU1, UNF1
NEU3
0.258
0.983
2.128
HNO1, URO1.1.3
URO1.1
0.253
0.988
2.119
KAR1, NEU2.1
NEU3
0.259
0.978
2.116
NEU3, UNF1
NEU1
0.258
0.994
2.111
NEU1, UNF1.1
NEU3
0.286
0.975
2.110
URO1.1.3, VIS1
URO1.1
0.265
0.983
2.108
GAE1, URO1.1.3
URO1.1
0.264
0.983
2.108
DER1, URO1.1.3
URO1.1
0.261
0.983
2.108
NEU2, UNF1.1
NEU3
0.271
0.973
2.107
HNO1.1, NEU1
NEU3
0.271
0.973
2.107
HAE2, URO1.1.3
URO1.1
0.253
0.983
2.107
URO1.1.1, URO1.1.3
URO1.1
0.252
0.983
2.106
UNF1.1, VIS1
NEU3
0.264
0.973
2.105
NEU2.1, UNF1.1
NEU3
0.259
0.972
2.104
GYN1, UNF1
NEU3
0.253
0.971
2.103
URO1.1.1, VIS1
URO1.1
0.286
0.980
2.100
GAE1.1, NEU2.1
NEU3
0.288
0.970
2.099
DER1, URO1.1.1
URO1.1
0.277
0.979
2.099
GAE1, URO1.1.1
URO1.1
0.277
0.979
2.099
GAE1.1, UNF1.1
NEU1
0.250
0.988
2.098
HAE2, URO1.1.1
URO1.1
0.271
0.978
2.098
PNE1, URO1.1.1
URO1.1
0.264
0.978
2.096
BEW3, URO1.1.1
URO1.1
0.261
0.978
2.096
GEB1, URO1.1.1
URO1.1
0.259
0.978
2.096
NEU1, ONK1
NEU3
0.270
0.968
2.095
END1, URO1.1.1
URO1.1
0.256
0.977
2.095
HAE3, URO1.1.1
URO1.1
0.255
0.977
2.095
GAE1.1, URO1.1.1
URO1.1
0.252
0.977
2.094
KAR1.1, RHE1
NEU3
0.262
0.967
2.093
END1, UNF1
NEU3
0.256
0.966
2.092
KAR1, NEU3
NEU1
0.286
0.985
2.091
GEB1, UNF1.1
NEU3
0.253
0.966
2.091
NEP1, NEU2.1
NEU3
0.252
0.966
2.090
HNO2, NEU3
NEU1
0.282
0.984
2.090
KAR1.1, NEU3
NEU1
0.268
0.984
2.089
URO1.1.3
URO1.1
0.276
0.974
2.087
URO1, URO1.1.3
URO1.1
0.276
0.974
2.087
BP, URO1.1.3
URO1.1
0.276
0.974
2.087
HNO2, NEU1
NEU3
0.282
0.964
2.087
GAE1.1, NEU1
NEU3
0.322
0.964
2.087
BEW1, URO1.1.3
URO1.1
0.274
0.974
2.087
GYN1, UNF1
NEU1
0.256
0.983
2.087
GEB1, UNF1
NEU1
0.250
0.982
2.086
GYN1, URO1.1.3
URO1.1
0.270
0.973
2.086
35
Table 8: Typical SPLG combina ions o public hospi als
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 151,372 ules iden i ied.
An eceden s
Consequen
Suppo
Con idence
Li
AUG1.4, VIS1.2
AUG1.5
0.276
1.000
3.280
AUG1.4, VIS1.1
AUG1.5
0.276
0.986
3.232
ANG3, AUG1.4
AUG1.5
0.264
0.985
3.230
AUG1.2, AUG1.4
AUG1.5
0.256
0.984
3.229
ANG3, KAR1.1.1
KAR1.2
0.264
0.970
3.225
ANG3, KAR1.3
KAR1.2
0.264
0.970
3.225
AUG1.4, THO1.1
AUG1.5
0.272
0.971
3.185
AUG1, AUG1.4
AUG1.5
0.260
0.970
3.181
AUG1.4, THO1.2
AUG1.5
0.276
0.958
3.141
AUG1.4, THO1
AUG1.5
0.276
0.958
3.141
AUG1.4, URO1.1.1
AUG1.5
0.276
0.958
3.141
AUG1.4, BEW8
AUG1.5
0.276
0.958
3.141
AUG1.4, RAO1
AUG1.5
0.272
0.957
3.139
AUG1.4, URO1.1.4
AUG1.5
0.272
0.957
3.139
AUG1.4, RHE2
AUG1.5
0.272
0.957
3.139
AUG1.4, UNF1
AUG1.5
0.272
0.957
3.139
AUG1.4, URO1.1.2
AUG1.5
0.268
0.957
3.137
AUG1.4, URO1.1.8
AUG1.5
0.268
0.957
3.137
AUG1.4, DER1.1
AUG1.5
0.268
0.957
3.137
AUG1.4, HER1
AUG1.5
0.264
0.956
3.135
AUG1.4, KIE1
AUG1.5
0.260
0.955
3.133
AUG1.4, NUK1
AUG1.5
0.252
0.954
3.129
AUG1.4, NCH1.1
AUG1.5
0.252
0.954
3.129
AUG1.4, GEB1.1
AUG1.5
0.252
0.954
3.129
AUG1.4, UNF2
AUG1.5
0.252
0.954
3.129
NCH1.1, GYNT
GEFA
0.252
1.000
3.114
HNO1.1.1, GYNT
GEFA
0.252
1.000
3.114
THO1.2, GYNT
GEFA
0.264
1.000
3.114
NCH1.1, BEW7.1
GEFA
0.252
1.000
3.114
THO1.2, BEW7.1
GEFA
0.264
1.000
3.114
AUG1.5, VIS1.2
AUG1.4
0.276
0.958
3.100
AUG1.5, URO1.1.2
AUG1.4
0.268
0.957
3.096
ANG3, AUG1.5
AUG1.4
0.264
0.956
3.094
AUG1, AUG1.4
ANG3
0.264
0.985
3.067
DER1.1, GYNT
GEFA
0.268
0.971
3.022
AUG1.4, NUK1
ANG3
0.256
0.969
3.018
AUG1.4, GEB1.1
ANG3
0.256
0.969
3.018
GEB1.1, GYNT
GEFA
0.252
0.969
3.017
AUG1.2, AUG1.4
ANG3
0.252
0.969
3.017
URO1.1.1, VIS1.3
ANG3
0.252
0.969
3.017
VIS1.1, VIS1.2
ANG3
0.305
0.962
2.994
AUG1, VIS1.2
ANG3
0.297
0.961
2.991
AUG1.2, VIS1.1
ANG3
0.297
0.961
2.991
AUG1.2, VIS1.2
ANG3
0.293
0.960
2.989
NUK1, VIS1.2
ANG3
0.285
0.959
2.986
GEB1.1, VIS1.2
ANG3
0.285
0.959
2.986
VIS1.2, VIS1.4
ANG3
0.272
0.957
2.980
DER1.1, BEW7.1
GEFA
0.268
0.957
2.979
AUG1.4, THO1.1
ANG3
0.268
0.957
2.979
AUG1.4, AUG1.5
ANG3
0.264
0.956
2.977
36
Table 9: SPLG combina ions linked wi h p o i abili y o p i a e hospi als
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; mo e han 1 million ules
iden i ied.
An eceden s
Consequen
Suppo
Con idence
Li
AUG1.2, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, HNO1.1
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, URO1.1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW7, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF2, VIS1
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW3, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF2, HNO1.2
P o i abili y
0.052
1.000
1.617
AUG1.2, DER1, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GAE1, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF2, GYN1
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW6, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF2, URO1
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW5, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW2, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW1, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, BP, GEF2
P o i abili y
0.052
1.000
1.617
AUG1.2, GEF1, GYN1.3
P o i abili y
0.052
1.000
1.617
AUG1.2, BEW7, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, GYN1.3, VIS1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW3, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, GYN1.3, HNO1.2
P o i abili y
0.051
1.000
1.617
AUG1.2, DER1, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, GAE1, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, GYN1, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW6, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, GYN1.3, URO1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW5, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW2, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW1, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BP, GEF2, GYN1.3
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BEW7, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GEF2, VIS1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BEW3, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GEF2, HNO1.2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, DER1, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GAE1, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GEF2, GYN1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BEW6, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, GEF2, URO1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BEW5, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BEW2, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW1, BEW10, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW10, BP, GEF2
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, HNO1.1, URO1.1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW7, GEF2, HNO1.1
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, HNO1.1, VIS1
P o i abili y
0.051
1.000
1.617
AUG1.2, BEW3, GEF2, HNO1.1
P o i abili y
0.051
1.000
1.617
AUG1.2, GEF2, HNO1.1, HNO1.2
P o i abili y
0.051
1.000
1.617
37
Table 10: SPLG combina ions linked wi h p o i abili y o public hospi als
No e: Top 50 ules lis ed as pe de ined pa ame e s (see me hodology), so ed op down by li ; 641,815 ules iden i ied.
An eceden s
Consequen
Suppo
Con idence
Li
AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GYN1.2, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GYN1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
ANG2, AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.5, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GEF2, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GYN1.4, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GYN1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HAE1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, BEW11, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, AUG1.4, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, AUG1.5, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, KAR1.2, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, BEW9, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, VIS1.3
P o i abili y
0.053
1.000
2.050
ANG3, AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, VIS1.2
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, KAR1.1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, NCH1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, BEW10, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, VIS1.4.1
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, VIS1.1
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, KAR1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, NUK1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1, AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, NCH1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.2, AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, THO1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, HNO1.1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, PNE1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.2, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, THO1.2, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GEB1.1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, PNE1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GEB1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, BEW8.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, URO1.1.8
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, NCH3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, HNO1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, RAO1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, DER1.1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, THO1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GEF3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.6, VIS1.4
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.4, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, HER1.1.3, URO1.1.1, URO1.1.6
P o i abili y
0.053
1.000
2.050
AUG1.3, GEF1, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
ANG1, AUG1.3, HER1.1.3, URO1.1.6
P o i abili y
0.053
1.000
2.050
