The increase of public health care expenditure (PHCE) of Swiss cantons doubles before elections once a health minister faces re-election. Hospital spending is the main driver for this result. Outcome-based indicators, measuring the number of hospitals and beds, confirm these findings. There are indications of a redistribution pattern within total PHCE, in which additional expenditure in acute care is compensated for in other areas. Opportunistic policies regarding the number of acute care hospitals are found to be particularly strong among health ministers at risk of being voted out of office.