[Incidence of operations in Switzerland related to insurance status]

Several studies reported in the literature show that surgical procedures can be carried out for other than clinical indications. In Switzerland, no statistics on the "demography" of surgical procedures are available. But an earlier analysis of the "Swiss Health Survey 1992/93" gave first indications on differences in rates of surgical procedures (hysterectomy, appendectomy, tonsillectomy and operation of the hip and gallbladder) by sex, educational status and region. This study, based on the same datasource (N = 10792), reveals an additional link with the health insurance status. The prevalence of surgical procedures is higher in privately insured than in persons with only basic insurance, independent of age, sex and region. The highest rates of surgical procedures (except tonsillectomy) are found among privately insured persons with a low educational status. Among 25-74 year old privately insured women, the lifetime-prevalence of a hysterectomy is 30% with low and 13% with high educational status (p < .001). The corresponding prevalences of at least one of the mentioned surgical procedures (without tonsillectomy) are 49% versus 28% (p < .001). As these are lifetime-prevalences, these rates do not necessarily reflect the actual surgical procedures. However, an analysis of the period of operation for hysterectomy and for the gallbladder shows the same pattern as the mentioned lifetime-prevalences. Higher rates among privately insured are also a frequent finding in the international literature. These findings should stimulate patients to ask for a "second opinion". Furthermore, there is an urge for the implementation of general hospital statistics to verify such findings. In addition, the scientific consensus on the indication of several surgical procedures should be promoted on the way to more evidence-based-medicine.