Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many European countries (e.g. Denmark, Italy, the Netherlands, Norway, Portugal, the Slovak Republic, Spain and the United Kingdom), patients are required, or given incentives to consult a general practitioner (GP) “gatekeeper” about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g. Austria, the Czech Republic, Iceland, Japan and Korea), patients may approach specialists directly.

Progress in medical technologies continues to transform health care delivery and to improve life expectancy and quality of life, but it is also one of the main drivers of rising health expenditure across OECD countries. This section presents data on the availability and use of two diagnostic technologies – computed tomography (CT) scanners and magnetic resonance imaging (MRI) units.

The number of hospital beds provides a measure of the resources available for delivering services to inpatients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative (acute), psychiatric, long-term and other types of care. It also includes an indicator of bed occupancy rates focussing on curative care beds.

Hospital discharge rates measure the number of patients who leave a hospital after receiving care. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the demand for hospital services, the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.

The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a greater readmission rate, costs per episode of illness may fall only slightly, or even rise.

Heart diseases are a leading cause of hospitalisation and death in OECD countries (see Indicator 1.3). Coronary angioplasty is a revascularisation procedure that has revolutionised the treatment of ischemic heart diseases (heart attack and angina) over the past 20 years. It involves the threading of a catheter with a balloon attached to the tip through the arterial system into the diseased coronary artery. The balloon is inflated to distend the coronary artery at the point of obstruction. The placement of a stent to keep the artery open accompanies the majority of angioplasties. Drug-eluting stents (a stent that gradually releases drugs) are increasingly being used to stem the growth of scar-like tissue surrounding the stent.

Significant advances in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to nearnormal function.

End-stage renal failure (ESRF) is a condition in which the kidneys are permanently impaired and can no longer function normally. Some of the main risk factors for end-stage renal failure include diabetes and hypertension, two conditions which are becoming more prevalent in OECD countries. In the United States, diabetes and hypertension alone accounted for over 60% of the primary diagnoses for all ESRF patients (37% for diabetes and 24% for hypertension) (USRDS, 2008). When patients reach end-stage renal failure, they require treatment either in the form of dialysis or through kidney transplants. Treatment through dialysis tends to be more costly and results in a poorer quality of life for patients than a successful kidney transplant, because of its recurrent nature.

Rates of caesarean delivery as a percentage of all live births have increased in all OECD countries in recent decades, although in a few countries this trend has reversed over the past few years. Reasons for the increase include reductions in the risk of caesarean delivery, malpractice liability concerns, scheduling convenience for both physicians and patients, and changes in the physician-patient relationship, among others. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries (Minkoff and Chervenak, 2003; Bewley and Cockburn, 2002; Villar et al., 2006). These concerns, combined with the greater financial cost (the average cost associated with a caesarean section is at least two times greater than a normal delivery in many OECD countries; Koechlin et al., 2010), raise questions about the appropriateness of some caesarean delivery that may not be medically required.

In the past two decades, the number of surgical procedures carried out on a same-day basis, without any need for hospitalisation, has grown in most OECD countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have also improved patient safety and health outcomes for patients, and have in many cases helped to reduce the unit cost per intervention by shortening the length of stay in hospitals. However, the impact of the rise in same-day surgeries on health spending depends not only on changes in their unit cost, but also on the growth in the sheer number of procedures performed, and needs to take into account any additional cost related to post-acute care and community health services.

The consumption of pharmaceuticals is increasing across OECD countries, not only in terms of expenditure (see Indicator 7.4 “Pharmaceutical expenditure”), but also the volume or quantity of drugs consumed. One of the factors contributing to this rise is a growing demand for drugs to treat ageing-related diseases. However, the rise in pharmaceutical consumption is also observed in countries with younger populations, indicating that other factors, such as physicians’ prescription habits, also play a role.