Following the Movers: Quantifying Place-Specific Effects on Swiss Healthcare Spending

Following the Movers: Quantifying Place-Specific Effects on Swiss Healthcare Spending | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Following the Movers: Quantifying Place-Specific Effects on Swiss Healthcare Spending Stefan Meyer, Stefan Felder This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8190498/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract We estimate the contribution of place-specific (supply-side) factors to the regional variation in healthcare expenditure in Switzerland using anonymized claims that cover 1.45 million individuals between 2015 and 2023. Exploiting an event-study movers design that follows 144,856 individuals who relocated across 42 health insurance areas, and controlling for individual fixed effects and time-varying covariates, we quantify how much individual health spending adjusts toward the average level of the destination region. We find that roughly half of regional spending differences are attributable to location (place) effects: the pooled place-effect is 0.54 – a move to an area with 10% higher average expenditure is associated with a 5.4% increase in individual spending. The effects of location are concentrated in outpatient services (0.64) and pharmaceuticals (0.50), are small for long-term care (0.18) and are not detectable for hospital spending. The effects are asymmetric: moves to higher-expenditure areas produce sizable upward adjustments (place-effect 0.56), while moves to lower-spending areas show little convergence. We also find evidence for a correlation of supply and demand factors: individuals with higher latent health needs are more likely to reside in higher-supply areas. Although not a definitive proof of supplier-induced demand, the results imply that supply availability and demand-side factors jointly drive substantial regional expenditure variation. Policy implications include the potential for coordinated supply-side planning and insurer-led capacity governance to curb inefficient cost growth. healthcare expenditure regional variation supply-side factors movers design healthcare utilization Switzerland event-study analysis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 09 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers invited by journal 02 Dec, 2025 Editor assigned by journal 01 Dec, 2025 Submission checks completed at journal 30 Nov, 2025 First submitted to journal 24 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8190498","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554856466,"identity":"edaea4f3-d952-4e15-9af8-70cd3bfea502","order_by":0,"name":"Stefan Meyer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYJCCD8gsHgMQg7EBj3o2BsYZMDaIRaIWZh4gQVCL/Pzmgw0/dzBE80skH/ts23ZHxpz9+AMGoAhOYHCMLbGx9wxD7swZacmzc9ue8Vj25BgwAkVwa2HjMX/A28aQu+FGjjFzbtthHoMDOQzMjG14HNbG/7HxL1DL/hv5n5ktQVrOP3+AVwvDMR7GZrAtEjnMQJVALTcSDPBqMTiWZtgs2yaRO+PMM2PGnnOHeSxnvDE42IvPYc2HHza+bbPJ7W9Pfszwo+ywvTl/+sMHP/E5DAIkGBgEEhDcAwQ1gAE/kepGwSgYBaNg5AEAzDZTYxXnvF4AAAAASUVORK5CYII=","orcid":"","institution":"University of Basel","correspondingAuthor":true,"prefix":"","firstName":"Stefan","middleName":"","lastName":"Meyer","suffix":""},{"id":554856467,"identity":"eb7e4b43-d054-4247-b156-6880a4a74d99","order_by":1,"name":"Stefan Felder","email":"","orcid":"","institution":"University of Basel","correspondingAuthor":false,"prefix":"","firstName":"Stefan","middleName":"","lastName":"Felder","suffix":""}],"badges":[],"createdAt":"2025-11-24 07:38:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8190498/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8190498/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97481403,"identity":"db02da3b-5e7e-4409-b0bf-162170e9cff5","added_by":"auto","created_at":"2025-12-04 22:07:52","extension":"json","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4712,"visible":true,"origin":"","legend":"","description":"","filename":"4f08469cd8e4455d84af081279f6c120.json","url":"https://assets-eu.researchsquare.com/files/rs-8190498/v1/34f083b6361fd0a96906e714.json"},{"id":97669435,"identity":"bb3e64da-3ba3-4408-986b-be0c32c7cdaf","added_by":"auto","created_at":"2025-12-08 09:27:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4572095,"visible":true,"origin":"","legend":"","description":"","filename":"SIRegionalVariationofHCE.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8190498/v1_covered_764e70cf-0c2e-4a76-9df1-a596ef35af07.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Following the Movers: Quantifying Place-Specific Effects on Swiss Healthcare Spending","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"swiss-journal-of-economics-and-statistics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sjes","sideBox":"Learn more about [Swiss Journal of Economics and Statistics](https://sjes.springeropen.com/)","snPcode":"41937","submissionUrl":"https://submission.nature.com/new-submission/41937/3","title":"Swiss Journal of Economics and Statistics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"healthcare expenditure, regional variation, supply-side factors, movers design, healthcare utilization, Switzerland, event-study analysis","lastPublishedDoi":"10.21203/rs.3.rs-8190498/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8190498/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"We estimate the contribution of place-specific (supply-side) factors to the regional variation in healthcare expenditure in Switzerland using anonymized claims that cover 1.45 million individuals between 2015 and 2023. 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