Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data

doi:10.1136/bmj.327.7426.1257

BMJ 2003;327:1257 (29 November), doi:10.1136/bmj.327.7426.1257

Paper

Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data

Chris Ham, director¹, Nick York, senior economic adviser², Steve Sutch, senior consultant and analytical and statistical services manager³, Rob Shaw, economic adviser²

¹ Strategy Unit, Department of Health, London SW1A 2NS, ² Economics and Operational Research Division, Department of Health, Leeds LS2 7UE, ³ NHS Information Authority, Winchester SO22 5DH

Correspondence to C Ham Chris.Ham{at}doh.gsi.gov.uk

Objective To compare the utilisation of hospital beds in theNHS in England, Kaiser Permanente in California, and the Medicareprogramme in the United States and California.

Design Analysis of routinely available data from 2000 and 2001on inpatient admissions, lengths of stay, and bed days in populationsaged over 65 for 11 leading causes of use of acute beds.

Setting Comparison of NHS data with data from Kaiser Permanentein California and the Medicare programme in California and theUnited States; interviews with Kaiser Permanente staff and visitsto Kaiser facilities.

Results Bed day use in the NHS for the 11 leading causes isthree and a half times that of Kaiser's standardised rate, almosttwice that of the Medicare California's standardised rate, andmore than 50% higher than the standardised rate in Medicarein the United States. Kaiser achieves these results througha combination of low admission rates and relatively short stays.The lower use of bed days in Medicare in California comparedwith Medicare in the United States suggests there is a "Californiaeffect" as well as a "Kaiser effect" in hospital utilisation.

Conclusion The NHS can learn from Kaiser's integrated approach,the focus on chronic diseases and their effective management,the emphasis placed on self care, the role of intermediate care,and the leadership provided by doctors in developing and supportingthis model of care.

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