Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;32(1):e1937.
doi: 10.1002/mpr.1937. Epub 2022 Aug 17.

Mental health service areas in Switzerland

Niklaus Stulz  1 , Reto Jörg  2 , Constanze Reim-Gautier  1 , Charles Bonsack  3 , Philippe Conus  3 , Sara Evans-Lacko  4 , Kerstin Gabriel-Felleiter  5 , Eva Heim  6 , Matthias Jäger  7 , Martin Knapp  4 , Dirk Richter  8 , Andres Schneeberger  9 , Graham Thornicroft  10 , Rafael Traber  11 , Simon Wieser  12 , Alexandre Tuch  2 , Urs Hepp  13   14
Affiliations

Mental health service areas in Switzerland

Niklaus Stulz et al. Int J Methods Psychiatr Res. 2023 Mar.

Abstract

Objectives: Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA-PSY) in Switzerland.

Methods: We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA-PSY based on travel patterns between patients' residences and service sites. Resulting HSA-PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services.

Results: We identified 68 HSA-PSY, which were reviewed and validated by local mental health services experts. The population-based rate of inpatient and outpatient service utilization varied considerably between HSA-PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA-PSY.

Conclusions: Wide variation of service use between HSA-PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small-scale regional level provides a good analytical framework.

Keywords: geography; psychiatry; service use; small area analysis.

PubMed Disclaimer

Conflict of interest statement

All other authors received no specific grant related to this study from any funding agency, commercial or not‐for‐profit sectors.

Figures

FIGURE 1
FIGURE 1
Swiss map with the 68 health service areas for psychiatric outpatient care (HSA‐PSY)
FIGURE 2
FIGURE 2
Number of (a) outpatient visits, (b) hospitalizations, and (c) hospital bed days per 1000 inhabitants and year in the 68 health service areas for psychiatric outpatient care (HSA‐PSY). CH, Switzerland
FIGURE 3
FIGURE 3
(a) Rate of hospitalizations and rate of outpatient visits per 1000 inhabitants and year in the 68 health service areas for psychiatric outpatient care (HSA‐PSY). (b) Rate of hospital bed days and rate of outpatient visits per 1000 inhabitants and year in the 68 health service areas for psychiatric outpatient care (HSA‐PSY)
See this image and copyright information in PMC

References

    1. Almog, M. , Curtis, S. , Copeland, A. , & Congdon, P. (2004). Geographical variation in acute psychiatric admissions within New York city 1990–2000: Growing inequalities in service use? Social Science & Medicine, 59(2), 361–376. 10.1016/j.socscimed.2003.10.019 - DOI - PubMed
    1. Ashton, C. M. , Petersen, N. J. , Souchek, J. , Menke, T. J. , Yu, H. J. , Pietz, K. , Eigenbrodt, M. L. , Barbour, G. , Kizer, K. W. , & Wray, N. P. (1999). Geographic variations in utilization rates in Veterans Affairs hospitals and clinics. New England Journal of Medicine, 340(1), 32–39. 10.1056/NEJM199901073400106 - DOI - PubMed
    1. Birkmeyer, J. D. , Sharp, S. M. , Finlayson, S. R. , Fisher, E. S. , & Wennberg, J. E. (1998). Variation profiles of common surgical procedures. Surgery, 124(5), 917–923. 10.1016/s0039-6060(98)70017-0 - DOI - PubMed
    1. Bundesamt für Statistik . (2018). Arbeitsmarktregionen 2018. Retrieved from https://www.bfs.admin.ch/bfs/de/home/statistiken/querschnittsthemen/raeu...
    1. Bundesamt für Statistik . (2020). Ständige Wohnbevölkerung nach Alter, Kanton, Bezirk und Gemeinde, 2010–2019. Retrieved from https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/stand‐entw...

Publication types