The evolution of hospital systems 33 suggest that the importance of the hospital in the health care system is diminishing, but other indicators such as patient admissions suggest that hospitals are busier than ever. As the functions of the hospital change, better information is needed on the ambulatory care services and day surgery now provided by hospitals. There are several implications for policy-makers. First, international comparative data offer no simple answer to how many hospital beds a country needs. Many countries have considerable scope for reducing existing hospital capacity by moving long-stay patients into more appropriate facilities. This does not, however, mean that all countries should emulate those with low levels of hospital capacity, since there is some concern that such low levels may be inadequate given current needs (Department of Health 2000). As one commentator has noted, no model will fit everywhere, and the policy-maker must be prepared to ‘think different’ (Smith 1999). Second, where hospital capacity is regarded as excessive, planning strategies appear to work better than leaving the reconfiguration process to market forces. In particular, independent single hospitals are especially resistant to closure, while change may need to be accompanied by the creation of new organizational entities and even new facilities. Thus, it might be better for the term ‘downsizing’ to be replaced by ‘reconfiguration’. Specifically, it should not be assumed that the problem of excess capacity can be addressed simply by closing some existing facilities and leaving others that are equally ill-equipped to address future challenges. Finally, the largest reductions in hospital capacity in eastern Europe have arisen not from carefully planned processes but rather because of war or economic collapse. In other words, systems have been forced to react to external circumstances rather than anticipating them.
References Arnould, R.J., DeBrock, L.M. and Radach, H.L. (1997) The nature and consequences of provider consolidations in the US, in B. Ferguson, T. Sheldon and J. Posnett (eds) Concentration and Choice in Healthcare. London: Royal Society of Medicine Press. Aro, S., Noro, A. and Salinto, M. (1997) Deinstitutionalization of the elderly in Finland 1981–91, Scandinavian Journal of Social Medicine, 25(2): 136–43. Browne, T. (1643/1986) Religio Medici, in The Oxford Dictionary of Quotations, 3rd edn. Oxford: Oxford University Press. Busse, R. (2000) Health Care Systems in Transition: Germany. Copenhagen: European Observatory on Health Care Systems. Christiansen, T., Enemark, U., Clausen, J. and Poulsen, P. (1999) Health care and cost containment in Denmark, in E. Mossialos and J. Le Grand (eds) Health Care and Cost Containment in the European Union. Aldershot: Ashgate. Club du Vieux Manoir (1977) Saint-Louis de la Salpêtrière. Paris: Nouvelles Éditions Latines. Corden, S. (2001) Case study: Australia, in A.S. Preker and A. Harding (eds) Innovations in Health Care Delivery: The Corporatization of Public Hospitals. Baltimore, MD: Johns Hopkins University Press. Department of Health (2000) Shaping the Future NHS: Long Term Planning for Hospitals and Related Services. London: Department of Health.