International trends in the provision and utilisation of hospital care

This article examines the pattern of change in hospital provision in established market economies, the countries of eastern Europe and the former Soviet Union, and lower income countries. Despite the great differences between these areas, hospitals in all systems have to deal with rising expectations and, more often than not, a need to contain the costs of health care. Outside the developing countries the generic response to this has been to reduce hospital stays and to improve the efficiency of the system, a strategy which seems to be at least partly successful. The experience of the health systems in the United States and the United Kingdom shows that cost pressures and changes in healthcare delivery mean that this strategy will lead to hospital mergers and closures in the longer term.