Supply, utilisation and outcome in hospital systems: an Anglo-Czech comparison

Abstract

In the 1990s health services in Czechoslovakia and England and Wales were fundamentally reorganised, and the former divided into the Czech Republic and Slovakia. In the Czech Republic in 1986 higher death rates from causes considered amenable to timely medical care were found relative to England in 1985, despite high hospital doctor supply, bed availability and discharge rates in the former. Inter-regional regression analyses in the specialities of general medicine and general surgery in 1986 suggested that, in both Czechoslovakia and England and Wales, the responsiveness of discharge rates to a relative scarcity or abundance of hospital beds was greater than that of length of stay. In Czechoslovakia these analyses in 1986 predicted that a 1% decrease in the bed supply rate would produce a decrease in the range 0.93–1% in discharge rates in general medicine and a 0.66–0.67% decrease in general surgery. Following the introduction of an insurance based service in the Czech Republic, a longitudinal analysis of the actual changes in bed utilisation showed that bed supply reductions were concomitant with increased discharge rates. Since cross-sectional analyses do not include the components of changes with time, for instance medical advances or management changes, care is required in their use for prediction. In the Czech Republic improved hospital performance, compared to that prevailing in 1986 and earlier, does appear to be taking place at the same time as health system changes. Given the prior poor performance and inferior quality indicators, the drive for radical rather than marginal change in Czech health services around 1990 is understandable.