Hospital discharge rates measure the
number of patients who leave a hospital after receiving care. Together with the average
length of stay, they are important indicators of hospital activities. Hospital activities
are affected by a number of factors, including the demand for hospital services, the
capacity of hospitals to treat patients, the ability of the primary care sector to prevent
avoidable hospital admissions, and the availability of post-acute care settings to provide
rehabilitative and long-term care services.
In 2009, hospital discharge rates were
the highest in Austria and France, although the high rate in France is partly explained by
the inclusion of some separations for same-day procedures (Figure 4.4.1). Discharge rates are also high in the Russian Federation,
Germany, the Slovak Republic, Poland and the Czech Republic. They are the lowest in
Mexico, Brazil and China. In general, those countries that have more hospital beds tend to
have higher discharge rates. For example, the number of hospital beds per capita in
Austria and Germany is more than twice than Spain and the United Kingdom, and discharge
rates are also about twice as large (see Indicator 4.3
"Hospital beds" ).
Across OECD countries, the main
conditions leading to hospitalisation in 2009 were circulatory diseases (which include
ischemic heart disease, stroke and other diseases), pregnancy and childbirth, diseases of
the digestive system, cancers, and injuries and other external causes.
Germany and Austria have the highest
discharge rate for circulatory diseases, followed by the Slovak Republic and Estonia
(Figure 4.4.2). The high rates in the Slovak Republic and
Estonia are associated with high mortality rate from circulatory diseases which may be
used as a proxy indicator for the occurrence of these diseases (see Indicator 1.3
"Mortality from heart disease and stroke" ). This is not the
case for Germany and Austria.
Austria and Germany also have the
highest discharge rates for cancers (Figure 4.4.3), although the
number of new cancer cases in these countries is only around the OECD average (see Indicator 1.11 "Cancer incidence" ). In Austria,
the high rate is associated with a high rate of hospital readmissions for further
investigation and treatment of cancer patients (European Commission, 2008a).
Trends in hospital discharge rates for
all conditions vary widely. In about one-third of OECD countries, discharge rates have
increased over the past ten years. These include countries where discharge rates were low
in 2000 (e.g. Korea, Mexico and Turkey) and others
where it was already above-average (e.g. Germany,
Poland and the Slovak Republic). In a second group of countries (e.g. Austria, Belgium, France, Spain, Sweden and the United Kingdom), they
have remained stable, while in the third group (including Canada, Denmark, Finland and
Italy), discharge rates fell between 2000 and 2009.
Trends in hospital discharges reflect
the interaction of several factors. Demand for hospitalisation may grow as populations
age, given that older population groups account for a disproportionately high percentage
of hospital discharges. For example, in Austria and Germany, 42% of all hospital
discharges in 2008 were for people aged 65 and over, more than twice their share of the
population. However, population ageing alone may be a less important factor in explaining
trends in hospitalisation rates than changes in medical technologies and clinical
practices. The diffusion of new medical interventions often gradually extends to older
population groups, as interventions become safer and more effective for people at older
ages (Dormont and Huber, 2006). However, the diffusion of new medical technologies may
also involve a reduction in hospitalisation if it entails a shift from procedures
requiring overnight stays in hospitals to same-day procedures. In the group of countries
where discharge rates have decreased over the past decade, there has been a strong rise in
the number of day surgeries (see Indicator 4.10, for example, for evidence on
the rise in day surgeries for cataracts).
Definition and comparability
Hospital discharge is defined as
the release of a patient who has stayed at least one night in hospital. It includes
deaths in hospital following inpatient care. Same-day discharges are usually excluded,
with the exceptions of Chile, France, Korea, Norway, Poland, the Slovak Republic,
Turkey and the United States which include some same-day separations.
Healthy babies born in hospitals
are excluded from hospital discharge rates in several countries (e.g. Australia, Austria, Canada, Chile, Estonia, Finland,
Greece, Ireland, Israel, Japan, Korea, Luxembourg, Mexico, Spain, Sweden, Turkey).
These comprise some 3-6% of all discharges.
Data for some countries do not
cover all hospitals. For instance, data for Denmark, Ireland, Mexico, New Zealand,
Poland, Sweden and the United Kingdom are restricted to public or publicly-funded
hospitals only. Data for Portugal relate only to public hospitals on the mainland
(excluding the Islands of Azores and Madeira). Data for Austria, Canada, Estonia,
Luxembourg and the Netherlands include only acute care/short-stay hospitals. Data for
Israel and Japan refer to acute care hospitalisations.