Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many countries (e.g., Denmark, Italy, Netherlands, Norway, Portugal, Slovak Republic, Spain and United Kingdom), patients are required or given incentives to consult a general practitioner (GP) about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries, patients may approach specialists directly.

New medical technologies are improving diagnosis and treatment, but they are also increasing health spending. This section presents data on the availability and use of two diagnostic technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT and MRI exams help physicians diagnose a range of conditions. Unlike conventional radiography and CT scanning, MRI exams do not expose patients to ionising radiation.

The number of hospital beds provides a measure of the resources available for delivering services to inpatients in hospitals. This section presents data on the number of hospital beds overall and for different types of care (curative care, psychiatric care, long-term care and other functions). It also includes an indicator of bed occupancy rates focussing on curative care beds.

Hospital discharge rates measure the number of patients who leave a hospital after staying at least one night. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.

The average length of stay in hospitals (ALOS) is often regarded as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a greater readmission rate, costs per episode of illness may fall only slightly, or even rise.

Heart diseases are a leading cause of hospitalisation and death in OECD countries (see indicator on Mortality from cardiovascular diseases in ). Coronary artery bypass graft and angioplasty have revolutionised the treatment of ischemic heart diseases in the past few decades. A coronary bypass is an open-chest surgery involving the grafting of veins and/or arteries to bypass one or multiple obstructed arteries. A coronary angioplasty is a much less invasive procedure involving the threading of a catheter with a balloon attached to the tip through the arterial system to distend the coronary artery at the point of obstruction; the placement of a stent to keep the artery open accompanies the majority of angioplasties.

Significant advances in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to near normal function.

Rates of caesarean delivery have increased in nearly all OECD countries, although in a few countries this trend has reversed at least slightly in the past few years. Reasons for the increase include the rise in first births among older women and in multiple births resulting from assisted reproduction, malpractice liability concerns, scheduling convenience for both physicians and patients, and the preferences of some women to have a caesarean section. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries, raising questions about the appropriateness of caesarean delivery that may not be medically required.

In the past few decades, the number of surgical procedures carried out on a same-day basis has increased markedly in OECD countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions and better anaesthetics, have made this development possible. These innovations have improved patient safety and health outcomes, and have also in many cases reduced the unit cost per intervention by shortening the length of stay in hospitals. However, the impact of the rise in same-day surgeries on health spending depends not only on changes in their unit cost, but also on the growth in the volume of procedures performed. There is also a need to take into account any additional cost related to post-acute care and community health services following the interventions.