The evolution of hospital systems 21
Hospital admissions per 100 population
Figure 2.4 Acute hospital admissions per 100 population in the European Union (䉏), countries of central and eastern Europe (�) and countries of the former Soviet Union (䉹) 24 22 20 18 16 14 12
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
10
Year Source: WHO (2001)
that the bed stock in the United Kingdom may now be too low for current demands (Department of Health 2000). Information about numbers of beds provides only a partial picture. A more comprehensive assessment requires knowledge of how many patients are admitted to hospital, how long they stay and how intensively the bed stock is used. Turning to admissions, responses to the falling numbers of beds have varied across Europe (Figure 2.4). The countries of the former Soviet Union show a spectacular fall from their high level of recorded admissions since the late 1980s. The reasons for this are discussed later in this chapter. In contrast, admissions in other parts of Europe began to increase in the 1990s. The volume of ambulatory care also rose, indicating an even greater increase in overall hospital activity in western Europe, for reasons that are still inadequately understood. Some of the change may, however, be attributable to patients who previously would have stayed for a prolonged period now having repeated admissions and discharges, so that the increase in people treated may be less than the trend lines suggest. The second perspective is how long patients remain in these beds (Figure 2.5). Many western European countries have moved patients who would formerly have remained in hospital for long periods into specialized facilities providing nursing care (such as nursing homes) or have discharged them back to their own homes with help from community-based health and social care services. Second, the length of stay for many acute conditions has been reduced