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In Japan, acute care^* patients stayed in the hospital for an average of 20.7 days in 2003. In the U.S., the average length of stay was 5.7 days. The average length of stay in OECD countries^** was 6.8 days.¹ Why did Japanese patients spend nearly three times as many days in the hospital compared to patients in other industrialized nations?

Of course the optimum length of a patient’s stay depends on his or her injury or disease, and there are many factors to consider. However, similar differences in length of hospital stay were found in a study evaluating patients with the same condition, acute myocardial infarction. Data regarding patients admitted to teaching hospitals in the United States, Japan, Brazil, Germany and Switzerland were analyzed.² The average length of stay ranged from 7.7 +/- 4.3 days in the American hospital to 47.2 +/- 27.9 days in the Japanese hospital.³ The researchers did not detect a difference in outcomes at one year. Although the U.S. hospital had the lowest prevalence of antero-septal myocardial infarction and the lowest use of thrombolytic therapy, the difference in average length of stay is noteworthy.

When Japanese researchers at the Hyogo Brain and Heart Center evaluated another specific condition, acute ischemic stroke, they found that the mean length of hospital stay for Japanese patients was 33 days, more than three times longer than in the United States.⁴ They explained that the variation may be due to a difference in hospital type or healthcare systems. For example, in Japan stroke centers usually provide care for the acute and subacute phases of stroke. They also mention that the payment system may influence the length of stay. In a separate analysis involving ischemic stroke, Senior Economist Reiko Suzuki of the Japan Center for Economic Research attributes the difference to the abundant supply of beds in Japan and the fee-for-service system which allows hospitals and patients to use health services as much as they like.⁵

The cost of health care is increasing around the world. Governments will have to raise taxes or people will have to pay more out of their own pockets if current trends continue. In order to reform health care systems and decrease costs, it is important to understand the impact of current policies and provide patients with incentives to take care of themselves (e.g., maintain a healthy weight and refrain from using tobacco). Incentives should also be used to encourage health care professionals to provide high quality medical care at the lowest possible cost.

*Acute care includes all types of medical care, excluding long-term care. It includes rehabilitative care, palliative care and acute psychiatric care.

**OECD stands for Organization for Economic Cooperation and Development. It consists of 30 countries committed to democratic government and the market economy, including Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Ireland, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, and United States.

Discussion questions

1. Please summarize the article. What is the main point of the article?
2. What is the average length of time that acute care patients stay in the hospital in Japan, the U.S.? What is the average length of stay for patients in OECD member nations?
3. Were similar differences in the average length of hospital stay found when researchers studied specific diseases? Please describe the findings of the studies evaluating acute myocardial infarction and ischemic stroke.
4. Why do Japanese patients spend nearly three times as many days in the hospital compared to other industrialized nations?
5. Do you think that Japanese patients spend too many days in the hospital? Why or why not?
6. Do you think that American patients spend too few days in the hospital? Why or why not?
7. What can be done to decrease health care costs?

References:

1. OECD Health Data 2005
2. de Porto Alegre, Brazil; Universitatsklinikum Charite, Germany; and Hopital Cantonal Universitaire de Geneve, Switzerland.
3. K Matsui, et. al. Management of patients with acute myocardial infarction at five academic medical centers: clinical characteristics, resource utilization, and outcome. Journal of Investigative Medicine. 1999 March; 47:134-40.　Accessed 23 October 2006
4. Yukihiro Yoneda, et. al. Hospital-based study of the care and cost of acute ischemic stroke in Japan. Stroke. 2003; 34:718.　Accessed 23 October 2006.
5. Reiko Suzuki. A comparison of health care technology: Why is treatment so different across countries? Japan Center for Economic Research. July 2003.　Accessed 23 October 2006.

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