What makes the hospitalisation system more efficient? An application of the decomposition method to Hong Kong morbidity data

Yip, Paul S F; Lee, Carmen K M; Chow, Chun-Bong; Lo, William T L

The total number of hospitalization days is the most crucial factor in determining financial funding and planning of the public hospital system in Hong Kong. Reducing hospital patient days has become one of the major health care policy and practice all over the world. [5, 16] Comparing with 26 OECD countries, the average length of stay for all diagnosis causes in Hong Kong hospitals dropped the most (30.0%) from 2002 to 2010, whereas that in Australia, New Zealand, United Kingdom and United States reduced 23.1%, 15.0%, 18.7% and 2.0%, respectively. The actual number of days in Hong Kong (6.3 to 4.4) was longer than that of Mexico (4.2 to 3.9) and United States (4.9 to 4.8) but had a similar range like in Australia (6.5 to 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r p e e r r e v i e w o n l y 13 5.0), Denmark (6.0 to 4.6), and Norway (5.7 to 4.5). However, does the significant drop of duration of stay in hospitals imply an improvement in health care services over time? A good quality of care is as essential as the efficiency of the health care system. Shortening in-hospital length of stay may be consistent with an orderly and systematic care pathway, but a longer length of stay might be regarded as appropriate for extended treatment. "The problematic nature of relationship between length of stay and quality needs to be acknowledged." [17] Our results showed that the mean duration of stay plays a very significant role in determining the number of hospitalization days against an overall hospital occupancy of 90%. Despite that, the frequency of visits per patient has increased from 1.98 to 2.14, and the hospital admission rate However, the workload for the medical and health staff due to the shorter stays has not been properly measured and reflected in cost considerations. A recent survey in Hong Kong public hospitals indicated a very high burn-out rate and increasing workload was one major factor. [22] Certainly, additional investment in human resources and equipment as well as utilization of newer technologies are measures that can counteract the effect of patients volume on health care workers workload. These are important service quality considerations in assessing the "cost-effectiveness" of shorter stays in the hospital.