From the Society

Hospital Medicine: An international specialty


So why all of this activity by hospitalists in countries whose health systems are so different from ours and from each other’s? What is it about our specialty that has captured the interest of physicians, health systems, and governments from around the globe?

Talking to hospitalists from abroad, the answer is very consistent and very simple. It is the desire to lower cost and improve the quality of care. It turns out that the American health care system is not the only one that struggles with these issues. It seems that health care costs are too high everywhere and that the quest for higher quality, lower cost health care is a universal struggle. As Scottish-born health care economist Ian Morrison jokes, “Every health care system sucks in its own way.”

Let’s look at Japan. They have the longest average life expectancy in the world at 84 years, with about a quarter of their population over 65 years of age. On any given day, almost 14% of the population has a physician visit. Historically, they also have long hospital length of stays with current average length of stay anywhere between 14 and 21 days. This, of course, is very costly. … and in their single-payer system, the entire cost of this care falls on the Japanese government. And as birth rates in Japan have decreased, there are fewer taxpayers to bear the financial burden of the progressively aging and sicker population.

Canada has a different challenge. Also a single-payer system, their largest issue for the acutely ill is the availability of an open hospital bed. Although the system varies somewhat from province to province, it is typical that hospitals are given a total annual budget that must cover all expenses for the year, independent of the volume of patients. Since most hospitals are perpetually full, the discharge of a patient results in another new admission, which in turn actually costs the hospital more money. This perverse incentive keeps hospital beds full as patients wait for one to open (especially for any elective procedure). Adding to the problem, physicians are paid fee for service and therefore also have no incentive to discharge patients.


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