Rethinking hospital planning: moving beyond cantonal boundaries towards fully integrated healthcare planning
13 April 2026 | Comment(s) |
Luca Strebel
Switzerland currently has around 275 hospitals operating across 590 sites. Responsibility for their planning lies with each canton, which acts simultaneously as a purchaser of services, a tariff-setting authority, a hospital operator and an economic promoter. This concentration of roles inevitably creates conflicts of interest and adds significant organisational complexity.
Yet hospitals remain the largest cost driver in the Swiss healthcare system: 36.3% of total costs in 2023. Effective hospital planning is therefore a key lever for improving cost efficiency. With this in mind, Groupe Mutuel is taking a close look at the future organisation of hospital care.
Political reality: many studies, few concrete measures
Although the need for political action is widely acknowledged, progress remains limited. Numerous parliamentary initiatives, work by the Conference of Cantonal Health Directors (CDS) and a recent Federal Council report all point in the same direction: assessments continue to multiply, but decisions lag behind. The CDS advocates a multi‑stage, long‑term process based mainly on recommendations rather than clear directives, while the Federal Council prefers, for the time being, to continue monitoring the situation.
A new study by the University of St Gallen, commissioned by Fondation Groupe Mutuel, clearly shows that cantons design their hospital planning without taking real population needs into account. In reality, patients frequently seek care well beyond cantonal borders.
Key findings of the study:
- 25 to 50% of treatments are already carried out outside the patient’s home canton.
- This applies to both basic hospital care and elective procedures.
- Patients are willing to travel long distances to receive higher-quality care.
Ultimately, what really matters to the population is quality, expertise and language - far more than geographical proximity or cantonal jurisdiction.
Structural inefficiencies due to limited coordination
An analysis of hospital workloads reveals significant duplication of services between neighbouring cantons. In most cantons, between one-third and four-fifths of hospitals provide 80 to 90% of treatments within a given service group. Such figures point to structural inefficiencies and a clear lack of coordination among stakeholders.
A necessary paradigm shift: from hospital planning to care planning
For Groupe Mutuel, the challenge is clear: we must move away from a purely hospital-based approach and adopt an integrated approach to care planning, based on patients’ actual care pathways. Quality must become the central criterion, as must the integration of the growing shift towards outpatient care.
Four concrete proposals for the future
1. Define five to seven inter-cantonal health regions
Rigid cantonal boundaries no longer reflect the way patients navigate the healthcare system. Supra‑regional structures are needed to better align with real patient behaviour.
2. Clearly define planning levels
- Highly specialised medicine: national coordination
- Specialist procedures: inter-cantonal coordination
- Primary care: cantonal level
3. Introduce binding quality criteria and quality-based remuneration models
Quality is the only guarantee of genuine transparency and long-term sustainability.
4. Joint planning of hospital and outpatient services
Hospital and outpatient services must be planned jointly. Neither a parochial mindset nor excessive centralisation leads to optimal results.
A binding middle ground must be found that is…
- pragmatic,
- quality-driven,
- and firmly focused on patients’ needs.
Today, Switzerland has a unique opportunity to shape the future of its hospital landscape – in the interests of everyone.
