What drives regional variation in hospital reform implementation? Insights from more than a decade of Swiss hospital planning.

Authors

Carla Walker, Charlotte Lang, Daria Bukanova-Berend, Katharina Lonnes, David Ehlig, Justus Vogel, Dr Alexander Geissler

Published in

Health policy OPEN. Volume 11. Pages 100190. Epub Oct 14, 2026.

Abstract

Implementing national hospital reforms is challenging in decentralised health systems, where subnational governments are responsible for execution. In 2012, Switzerland introduced a national hospital reform, with implementation delegated to cantons. By applying the Health Policy Triangle, we examine how cantons have implemented the national hospital planning reform and what factors explain observed variation.
We employed a mixed-methods design. A document analysis and 25 semi-structured interviews with experts and cantonal representatives were combined with an unsupervised cluster analysis, examining whether structurally similar cantons showed comparable patterns of deviation.Findings.By 2024, 25 out of 26 cantons had adopted service groups with varying introduction timepoints and diffusion toward a shared model. Differences in the number of service groups and most requirements were minor. In contrast, minimum volume requirements varied considerably, driven by political feasibility concerns and the perceived risk of financially destabilising local hospitals.
The Swiss case shows that voluntary harmonisation can emerge in decentralised health systems through policy diffusion, where one canton's planning approach became a de facto standard for others. However, convergence is incomplete where implementation decisions are politically sensitive and where administrative capacities are limited. Decentralised systems may benefit from stronger national standardisation combined with transparent mechanisms for local adaptation, enabling a balance between quality, cost, and access considerations.

PMID:
42927224
Bibliographic data and abstract were imported from PubMed on 25 Oct 2026.

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