The changing pattern of medical activity in a major Belgian university hospital.
To evaluate the changes in the pattern of clinical activity in a 1900-bed Belgian teaching hospital in the period 1979-1987, we extracted data from the historical files of the hospital's central invoicing system. The total charge for a day of hospitalization, care and treatment increased by 83%. In this total per diem charge the share of hospital charges in the strict sense declined from 60 to 53%; the shares of charges for services and for pharmaceuticals rose, respectively, from 29 to 32, and from 10 to 15%. Within charges for services the share for diagnostic services declined by 22%; the share for surgery rose by 16%, and that for miscellaneous other services by 89%. For diagnostic services the decline was particularly clear for laboratory medicine (-32%) and for conventional imaging services (-22%), while cardiac and endoscopic investigations show a prominent expansion (+78 and +83%, respectively). In surgery the growth is quite homogeneous with the charges for urology, ophthalmology and orthopedics as the most important growers. In a group of miscellaneous, not diagnostic nor surgical services, which grows faster than all other groups, there is a marked shift from rather simple to technologically more advanced services. The increase in the pharmacy's bill results from increases in charge for both drugs (+49%) and materials (+95%). We conclude that the observed changes in charges reflect an intensification of care and an impact of technological innovation on clinical practice, including a phenomenon of substitution of old technologies for newer ones.
Vleugels
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University Hospitals Leuven, Belgium.
D001530:Belgium; D003625:Data Collection; D004059:Diffusion of Innovation; D004180:Direct Service Costs / Q000706:statistics & numerical data; D004470:Economics, Medical; D005249:Fees and Charges / Q000706:statistics & numerical data / Q000639:trends*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D013038:Specialization; D013675:Technology, High-Cost