Does the U.S. Health Care System Provide a Model for Hospital Use?

Because of the pressure on capacity and concern about bed blocking, particularly by elderly patients, interest in the use of intermediate care facilities (such as hospices and nursing homes) has grown. The health system in the United States provides an alternative model for the coordinated use of hospital beds and intermediate care facilities.

Yes, you read it correctly. The U.S. may be a model of coordinated care.

This quote is from a short paper on differences between discharge destinations and lengths of stay in U.S. and English hospitals for people aged 65 or over. It was published in the March 13, 2004 issue of the British Medical Journal. It found that average lengths of stay in NHS hospitals were more than double the average in U.S. hospitals, 6.7 days for stroke in the U.S. versus 26.9 days for stroke in England. Thirty-nine percent of U.S. patients were discharged to some form of intermediate care compared with 10% in England, and in-hospital death rates were 4.9 percent in the U.S. compared with 9.3% in England.

As 2000 OECD inpatient admission rates per 1,000 patients of all ages were 118 in the U.S. and 151 in England, the authors concluded that the U.S. was probably not admitting a higher proportion of minor cases. Their work, therefore, was seen as “raising questions about the appropriate use of hospital beds and availability of intermediate facilities in the United Kingdom…”

The most obvious difference between the U.S. and UK health care systems for people 65 and over is not that one is private and the other is run by government. Both, as we know, are run by government.

In the U.S., government run care is still benchmarked by a large private health care sector. Private sector health care tends to follow the money, focusing on what private payers want rather than on what political interest groups want. In 2007, OECD data suggested that the public sector controlled 45.4 percent of U.S. health care spending. In the United Kingdom, the public sector controlled 81.7 percent. Politically connected groups like NHS hospitals and those who work for them can use their political power to block system changes that they don’t like or haven’t thought of. In this case, it may have led them to block the expansion of stand alone nursing homes, an expansion that might have reduced the hospital share of the global NHS budget.

Politically controlled spending also gives government officials an incentive to cover up health care problems rather than to solve them. In August, the Telegraph reported that British Health Secretary Andy Brunham, in an interview on BBC Radio Five Live, said “We have no waiting lists now in the NHS and people have full choice of NHS hospitals.”

Three days later, government figures showed that a quarter of a million people had waited more than 18 weeks for treatment.

Comments (8)

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  1. Paul H. says:

    Great post. I’m not feeling inferior any more. Or, Im not feeling that our health care system is inferior.

  2. Devon Herrick says:

    It’s all about incentives. U.S. hospitals want to discharge patients because they typically receive a fixed reimbursement and need to admit new (revenue generating) patients the way restaurants turn tables to increase the number of paying customers.

    Since British (and Canadian) hospitals tend to be paid through global budgets, keeping the same patient to convalesce longer effectively blocks the likelihood that a costly-to-treat patient will be admitted.

  3. Ken says:

    I agree with Paul. We can all feel less inferior after this post.

  4. Bruce says:

    Someone should go post this at the Commonwealth Fund blog.

  5. Larry says:

    I didn’t know Commonwealth had a blog. Does this mean they are willing to go on line and defend themselves?

  6. The Patient Factor says:

    The post is correct in saying “Politically controlled spending also gives government officials an incentive to cover up health care problems rather than to solve them.” The government of Alberta released its 2010 provincial budget on February 9th. The budget absorbed the 1.3 billion dollar deficit of Alberta Health Services and allocated billons more in health care spending which will account for roughly 44% of provincial expenditures in 2010.

  7. Game Kids says:

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