The hospital of the future: Better out than in? Alternatives to acute hospital care

BMJ 1999;319:1127-1130 ( 23 October )

Education and debate

The hospital of the future

Better out than in? Alternatives to acute hospital care

This is the fourth in a series of seven articles

Martin Hensher, health economist, London Health Economics Consortium ^a, Naomi Fulop, senior lecturer in health services management and policy, Health Services Research Unit ^a, Joanna Coast, lecturer in health economics ^b, Emma Jefferys, health economist, London Health Economics Consortium ^a.

^a London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: M Hensher henshm@hltrsa2.pwv.gov.za

The first 150 words of the full text of this article appear below.

Changing technology is probably the main force driving the substitution of healthcare resources. This is because new treatments,procedures, and diagnostic techniques allow conditions to be managedin different settings by different staff. Such change is generallyincremental, but occasionally new technologies fundamentally changethe organisation of care. For example, the development of effectivechemotherapy in the 1940s allowed tuberculosis to be managed onan outpatient basis, which led directly to the closure of nearly30 000 hospital beds and the elimination of an entire class ofhospital. Advances in primary prevention might also, in the longterm, lead to a reduced need for admission to hospital. Yet suchstep changes are ultimately outside the hands of clinicians, managers,and policymakers, despite their intimate concern with the organisation,scale, and cost of the hospital sector. The policy debate hastended to focus on what might be described as the "appropriatenessgap" $---$ . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

GPled bed schemes offer another alternative: Owen Dempsey
bmj.com, 29 Oct 1999 [Full text]
role of policy interventions underplayed: Bernadette Purcell
bmj.com, 3 Dec 1999 [Full text]