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Education And Debate The hospital of the future

International trends in the provision and utilisation of hospital care

BMJ 1999; 319 doi: (Published 25 September 1999) Cite this as: BMJ 1999;319:845
  1. Martin Hensher, health economist, London Health Economics Consortiuma,
  2. Nigel Edwards, policy director (,
  3. Rachel Stokes, senior policy adviserc
  1. a London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b NHS Federation, London SE1P 4ND
  3. c Consumers' Association, London NW1 4DF
  1. Correspondence to: N

    This article examines the pattern of change in hospital provision in established market economies, the countries of eastern Europe and the former Soviet Union, and lower income countries. Despite the great differences between these areas, hospitals in all systems have to deal with rising expectations and, more often than not, a need to contain the costs of health care. Outside the developing countries the generic response to this has been to reduce hospital stays and to improve the efficiency of the system, a strategy which seems to be at least partly successful. The experience of the health systems in the United States and the United Kingdom shows that cost pressures and changes in healthcare delivery mean that this strategy will lead to hospital mergers and closures in the longer term.

    Summary points

    Increasing rates of admission are not just a British phenomenon

    Some countries have experienced reductions in admissions

    Almost all developed countries have made substantial reductions in beds, and in many places there is still further scope for this

    Eastern Europe and the former Soviet Union still have an overdeveloped hospital sector

    Hospitals are more of a growth industry in developing countries, but care is needed if the right investment is to be made

    Trends in the established market economies

    Medical practice, hospital management, and technology have undergone great changes over the past 20 years. This has led to substantial shifts in demand for secondary care facilities and notable changes in the types of facilities required. Hospital costs are the largest component of health expenditure in most countries in the Organisation for Economic Cooperation and Development (OECD), and they have therefore been a key focus in the drive for increased efficiency in the health sector.1 While this financial pressure has played a part in developments in the provision of secondary care, the influence of technology and …

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