Consultations with doctors are, for many people, the most frequent contact with health services, and often provide an entry point for subsequent medical treatment. Consultations can take place in doctors’ clinics, hospital outpatient departments or, in some cases, patients’ own homes. Increasingly, consultations occur online or by video call, to improve access for remote populations, or for consultations after regular hours.

Technology plays an important role in the health system, allowing physicians to better diagnose and treat patients. However, new technologies can also drive up costs, and are commonly acknowledged to be one of the main causes behind increases in health spending (Lorenzoni et al 2019[1]). This section presents data on the availability and use of two diagnostic imaging technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT and MRI exams help physicians diagnose a range of conditions.

The number of hospital beds provides an indication of the resources available for delivering services to inpatients. The influence of the supply of hospital beds on admission rates has been widely documented, confirming that a greater supply generally leads to higher admission numbers (Roemer’s Law that a “built bed is a filled bed”). Therefore policymakers are recognising that simply increasing the number of hospital beds will not solve problems of overcrowding or delays in hospitals.

The average length of stay in hospitals is often regarded as an indicator of efficiency in health service delivery. All else being equal, a shorter stay will reduce the cost per discharge and will shift care from inpatient to less expensive settings. Longer stays can be a sign of poor care coordination, resulting in some patients waiting unnecessarily in hospital until rehabilitation or long-term care can be arranged. At the same time, some patients may be discharged too early, when staying in hospital longer could have improved their health outcomes or reduced chances of re-admission.

Hip and knee replacements are some of the most frequently performed and effective surgeries worldwide. The main indication for hip and knee replacement (joint replacement surgery) is osteoarthritis, which leads to reduced function and quality of life.

Caesarean sections can be a lifesaving and necessary procedure. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries. This raises concerns over the growing rates of caesarean sections performed across OECD countries since 2000, in particular among women at low risk of a complicated birth who have their first baby by caesarean section for non-medical reasons. The World Health Organization concludes that caesarean sections are effective in saving maternal and infant lives, but that caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates at the population level. Nevertheless, caesarean sections should be provided based on need, rather than striving to achieve a specific rate.

In the past few decades, the number of surgical procedures carried out on a same-day basis has markedly increased in OECD countries. Advances in medical technologies – in particular the diffusion of less invasive surgical interventions – and better anaesthetics have made this development possible. These innovations have improved patient safety and health outcomes. Further, by shortening the treatment episode, same-day surgery can save important resources without any adverse effects on quality of care. It also frees up capacity within hospitals to focus on more complex cases or to reduce waiting lists. However, the impact of the rise in same-day surgeries on overall health spending may not be straightforward since the reduction in unit costs (compared to inpatient surgery), may be offset by overall growth in the volume of procedures performed. Any additional cost related to post-acute care and community health services following the interventions also need to be considered.