Hint: This homepage is best displayed with Google Chrome.
MOTIVATION
The health care costs in Switzerland increased from 7.9% to more than 11% of the Gross Domestic Product (GDP) between 1992 and 2014. The total costs in 2014 were above 71 billion Swiss Francs. Thus, Switzerland has one of the highest health expenses in Europe. Only the French and the Swedes spend more money on their health care than the Swiss in comparison to the GDP. Therefore, it is not surprising that the financial burden for the population is high even though public authorities make up for about one third of the health care costs (e.g. subventions for insurance rates or financial assistance for hospitals). This problem will no be alleviated within the next couple of years but rather getting worse since the costs of the health care system will further increase. The Federal Statistical Office predicts total health care costs of 16.7% of the GDP for 2030. Another challenge facing the country is a potential shortage of family doctors across rural regions of Switzerland. Mostly elderly people are affected by this phenomenon since they usually need more medical assistance and are often not able to cope with long journeys to their doctor. In order to understand how this problem arose despite continuously increasing health care costs, the focus of this project is to investigate the spatio-temporal distribution of doctors (family doctors and specialists) within the Canton of Zurich. Considering the project's content will allow answering the following research questions:
- How has the spatial distribution of doctors in the Canton of Zurich changed between 1998 and 2014?
- Is there a spatio-temporal dependency between the number of elderly people within the communities and the availability of doctors?
Answering these research questions will help to improve the knowledge about the Swiss health care system and its spatial dependencies in the canton of Zurich. This will be useful for making the health care more patient-friendly and cost-effective. To support this process, the following sections will not only contain a map visualizing the spatio-temporal distribution of doctors but also give a short overview of the Swiss health care system and its cantonal differences which need to be considered when applying findings to other parts of the country. Finally, background information will be provided in the form of newspaper articles, scientific papers as well as movies.
  Percentage of People Aged 65 and Older (1998)
  Percentage of People Aged 65 and Older (2014)
These two maps show the percentage of people aged 65 years and older in comparison to the total population. By comparing these two maps of 1998 and 2014 you can see that the percentage of elderly people has increased in almost all communities of the canton of Zurich – the percentage has dropped in only 10 out of 168 total communities. In many communities, the percentage of elderly people is nowadays twice as high as it was in 1998. However, there was an opposite trend within the big cities: The percentage of people with a minimal age of 65 years has decreased in both Zurich and Winterthur. In Zurich for example, the percentage of people aged 65 and older decreased from 20.4 % to 16%.
The absolute number of elderly people rose from 183'000 to 248'000 within the 14 years of available data which is an increase of 35%.
  Number of Doctors per 1000 Inhabitants (1998)
  Number of Doctors per 1000 Inhabitants (2014)
These two maps show the number of doctors per 1000 inhabitants for each community in the canton of Zurich. It is obvious at first glance that this number did not change a lot in most of the communities between 1998 and 2014. Only in the cities and its surrounding areas, the number of doctors increased significantly. Furthermore, communities with one or more hospitals have generally a higher proportion of doctors which of course also has to do with their more urban location. This pattern is the same for both years, 1998 and 2014. Please note that all hospitals were established before 1998 and still in use by 2014.
Even though these relative changes seem to be very little, the absolute number of registered doctors rose from 2602 in 1998 to 3694 in 2014. This is an increase of 42%. At the same time the population in the canton of Zurich grew from 1.2 million to 1.46 million which is only about half of the growth rate which can be found in the doctors statistic.
  Standardized Change of Elderly People Between 1998 and 2014
  Standardized Change of Doctors Between 1998 and 2014
Both maps are difference maps that were normalized by their standard deviation. Thus, the first map shows the change of elderly people in percent of the total population between 1998 and 2014 (percentage of elderly people in 2014 - percentage of elderly people in 1998) divided by the standard deviation of the total dataset. The second shows the same for the number of doctors per 1000 inhabitants.
Comparing both maps reveals that the population got older in almost all communities of the canton during the past years while the availability of doctors changed in a totally different way. There is a better overall availability of doctors in 2014 compared to 1998. However, the availability has a high spatial discrepancy. In about half of the communities, there was no or only a slight change according to the number of doctors per 1000 inhabitants. This implies that spatio-temporal changes in the availability of doctors does not reflect changes in the age structure.
Change of Doctors per 1000 Inhabitants Aging 65 Years and Above Between 1998 and 2014
This map summarizes the above gained information in a single display. It is showing the change of doctors per 1000 inhabitants aging 65 years and above between 1998 and 2014.
As we learned above, the number of doctors (+42%) has proportionally increased by a larger number than the overall population (+21.75%). Even the proportion of elderly people has grown less that the doctors (+35%). Therefore you might expect a summarizing map that is rather in green colors than in purple colors. However, this is not the case because the two major communities of the canton (Zurich and Winterthur) have a contrary development: The number of doctors is increasing while the percentage of elderly people is decreasing. This leads to a much higher availability of doctors for older people. Due to their large population, these two communities have a high impact on the overall statistics.
Conclusions
The Swiss health care system is highly decentralized. The federal authority is only responsible for some minor parts of the complex system (e.g. reproductive health, human gene technology or transplantation medicine) and its legal framework conditions. Key entities exist mainly within the cantons. These authorities are responsible for licensing providers, coordinating hospital services, subsidizing institutions, and promoting health awareness through disease prevention. Intercantonal coordination is not common but can be found in some areas of the health care system. It is on the other hand the community’s duty to coordinate other medical services like home care or school doctors. Thus, the responsibilities change from canton to canton and community to community (a detailed overview can be found in Kocher and Oggier (2007) which is listed in the link section below). This means that results gained within this project cannot be transferred to other cantons even though doctor shortage seems to be a national phenomenon. Cantonal differences of the health care systems as well as mentalities and geographical conditions have to be considered before making nationwide conclusions. Therefore, comparisons between Switzerland and other countries are even more difficult to accomplish. However, the data and maps shown above allow to state the following conclusions at cantonal level:
- The spatial distribution of doctors has not changed significantly between 1998 and 2014 in comparison to the population.
- However, there is a trend that, as of today, more doctors are working in higher populated areas where also the hospitals are located.
- There is a contrary development in the big cities comparing the proportion of elderly people to the availabilty of doctors: The number of doctors is increasing while the percentage of elderly people is decreasing. In fact most new doctors start working in the cities while elderly people are rather moving out of the cities.
- In comparison to that, the number of elderly people is rising in the rural areas while there is only little additional health care.
For further investigation, it would be interesting to distinguish between family doctors and specialists which is not yet possible due to missing distinction in the input data.
BACKGROUND INFORMATION
This section provides links to related papers and websites which can be useful due to the high relevance of the topic. The section consists of four subcategories: 1) health care in Switzerland with a focus on the canton of Zurich, 2) principles and techniques for visualizing spatio-temporal data on the computer, 3) websites providing useful data for further studies, and 4) clips highlighting the relevance of the topic.
Swiss Health Care System
- Federal Statistical Office FSO. (2016). Gesundheit. Taschenstatistik 2016. Download
- Gesundheitssystem leidet unter Hausarzt-Mangel. (2016, 4th September). SRF. Access
- Hudec, J. (2017, 5th January). Arztmangel auf dem Land. Doktor Gloor arbeitet an der Zukunft. Neue Zürcher Zeitung. Access
- Kocher, Gerhard (2007). Kompetenz- und Aufgabenverteilung Bund – Kantone – Gemeinden. In Kocher, G. & Oggier, W. (Eds.).Gesundheitswesen Schweiz 2007–2009. Eine aktuelle Übersicht. 109–118. Bern, BE: Verlag Hans Huber.
- Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (Eds.) (2016). International profiles of health care systems, 2015. Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Download
- Rosemann, T., & Schneemann, M. (2013). Der Hausärztemangel geht uns alle an. Praxis, 102(6):313-314. Download
- Walser, B. (2014, 20th March). Immer mehr Ärzte, und trotzdem herrscht regional Mangel. Tages Anzeiger. Access
Visualizing Spatio-Temporal Content
- Andrienko, N., Andrienko, G., & Gatalsky, P. (2003). Exploratory spatio-temporal visualization: an analytical review. Journal of Visual Languages & Computing, 14(6), 503-541. Download
- Crampton, J. W. (2002). Interactivity types in geographic visualization. Cartography and geographic information science, 29(2), 85-98. Download
- Fish, C., Goldsberry, K. P., & Battersby, S. (2011). Change blindness in animated choropleth maps: an empirical study. Cartography and Geographic Information Science, 38(4), 350-362. Download
- Harrower, M. & Fabrikant, S. (2008). The role of map animation for geographic visualization. In Dodge, M.,McDerby, M, &Turner, M. (Eds.), Geographic visualization, 49-65. Hoboken, NJ: John Wiley & Sons. Download
- Skarlatidou, A. (2010). Web-Mapping Applications and HCI Considerations for their Design. In Hakalay, M. (Ed.), Interacting with Geospatial Technologies 45–264. Hoboken, NJ: Wiley-Blackwell.
Websites
- Community portrait (canton ZH): Provides and visualizes statistical data for all administrative entities. Access
- Open Data Swiss: A lot of interesting data provided by several public institutions. Access
Clips
- SRF Puls. (March 25th, 2013). Hausärzte-Mangel in der Schweiz. Length: 18:54. Access
- SRF Schweiz aktuell. (April 20th, 2013). Akuter Hausarztmangel. Length: 05:03. Access
DATA SOURCES
The following section summarizes the data (spatial and non-spatial) used in this project. All of them are open data.
Data
- Community boundaries: Extracted from the WFS provided by the Canton of Zurich. It represents the boundaries in a scale of 1:5000 (overview map accuracy). Therefore, a generalized version of this dataset was used in this project. The original dataset can be accessed by the following URL: http://maps.zh.ch/wfs/GemZHWFS.
- Hospitals: Based on OpenStreetMap and downloaded from overpass turbo (Access ). This dataset was modified at some relevant parts: Polygons and lines were converted to points. Furthermore, some attributes were corrected based on information provided by the overview map from the Canton of Zurich.
- Doctors and age structure: Both were downloaded from the website of the Cantonal Statistical Office. They can be accessed from the categories health (Access ) as well as population status (Access ).
Metadata
- A detailed documentation of the community banoundaries can be found on Geolion (Access ), a website containing metadata for all geodata provided by the Canton of Zurich.
- Further information about the hospital point dataset can be found on OpenStreetMap Wiki (Access ).
- Metadata for the spreadsheets containing information about the doctors and the age structure are not available. However, the columns in the files are unambiguously named making any further information redundant.
ABOUT US
Matthias Saner
Geography student at UZH | Major: Specialized Master in GIScience
Matthias has completed a Bachelor of Arts in Social Sciences / Popular Culture Studies. He is now facing his Masters degree in GIScience. Beyond that, he is working as a taxi driver and as a chaperone for exchange students. In his free time, he enjoys playing badminton and playing the piano.
Raphael Prinz
Geography student at UZH | Major: GIScience, Minor: Informatics
Contact
Your e-mail has been sent. We will contact you as soon as possible.