Hospital systems. Data sources, bed supply and performance in hospital systems. An Anglo-Czechoslovak comparison

Abstract

Background: There were a number of similarities, except for their effectiveness, in the health care systems of Czechoslovakia and England and Wales between the Second World War and the late 1980s. In a comparison of Czechoslovakia with England and Wales, the objectives of this study were to examine data sources and to report time trends and regional distributions in hospital bed supply, hospital doctor supply and hospital utilisation. Methods: For the specialties of general medicine and general surgery in both countries from 1960 to 1986, data were collated on bed supply, hospital doctor supply, discharge rates and length of stay. Issues concerning the comparability of the data were addressed, for example those of the definitions of specialty, length of stay and casemix. Results: In the period 1960 to 1986, in the specialties of general medicine and general surgery, there was a relative excess in the supply of hospital doctors and beds in Czechoslovakia compared with England and Wales. Hospital performance in terms of discharge rates, discharges per bed and length of stay remained relatively static in Czechoslovakia during this period compared to marked increases in discharge rates and reduced length of stay in England and Wales. Both countries recorded reductions in the regional variation of bed and doctor supply and hospital utilisation. Conclusions: International studies of hospital utilisation need to be interpreted carefully in the light of definitions of hospital stay, casemix, the use of day cases and the availability of other services. Subject to these caveats, discharge rates were high and duration of stay long In Czechoslovakia compared with England and Wales; however, both countries achieved important improvements in regional equity.