ArticleBMC public health2026
Association between health care insurance type and rates of visceral surgical procedures in Switzerland. A population-based weighted retrospective cohort study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIndication for visceral surgical procedures should be based on clinical reasoning only and independent of financial incentives. Yet, there is a lack of studies investigating whether insurance type (basic vs. supplementary private) is associated with surgical procedure rates.
methodsIn this study we assessed whether incidence rates in adults with supplementary private insurance undergoing visceral surgical, non-emergency, in-patient procedures from 2012 to 2020 are higher compared to those with basic insurance only in Switzerland. We assessed incidence rates (IR) for basic only and supplementary private insurance stratified over time and by different age groups, and we fitted negative binomial regression models adjusted by inverse probability weights for specific visceral surgical procedures. We used primary or secondary discharge procedure codes for one of the following procedures: cholecystectomy, fundoplication, sigmoidectomy, rectopexy, haemorrhoidectomy, inguinal, femoral, and umbilical hernia repair.
resultsOf 1,954,119 surgical admissions (median age 63, 53.3% male, 15.3% non-Swiss nationality), 70.5% had basic insurance only. People with supplementary private insurance had a 7% higher probability (IRR, 1.07, 99% CI 1.06-1.07) to have a visceral surgical procedure done compared to people with basic insurance only-a result consistent across different types of procedures including cholecystectomy (IRR, 1.06, 99% CI 1.06-1.06), fundoplication (IRR, 1.09, 99% CI 1.09-1.10), sigmoidectomy (IRR, 1.10, 99% CI 1.10-1.10), rectopexy (IRR, 1.05, 99% CI 1.04-1.06), haemorrhoidectomy (IRR, 1.04, 99% CI 1.03-1.04), and hernia repair (IRR, 1.07, 99% CI 1.07-1.07). Sensitivity analyses, including side procedures, stratification by length of stay, and propensity score matching, suggested robustness of the results.
conclusionIn this cohort study, supplementary private insurance was independently associated with a higher probability of undergoing a visceral surgical procedure. The role of financial incentives in surgical procedures is still unclear.
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