Implications of shortening the time spent in hospital

The decision to shorten the time spent in most areas of hospital care is extremely complex and hinges on the balance of numerous resulting credits and debits, which are largely unknown. The length of stay in hospital can be stabilized for many categories of medical care but the likely benefits may be disappointingly small in the face of unchanged demand for health care. Furthermore, a sustained reduction in length of stay could bring with it logistic contractual and personal problems, the costs of which could outweigh the benefits of stabilization. The best delivery of health care in a closed financial system seems to depend on a joint consideration of output per unit time and a provision of a service that comes near to satisfying the true need for that service. The appropriate level of service will be decided from a study of the true prevalence of the need and the ability of the service to satisfy it. The enthusiastic pursuit of traditional efficiency without adequate information may be counterproductive--by increasing demand, by demoralizing the health personnel and by diverting some of the demand into private practice. Our first priority is the rationalization of demand; this will need the combined efforts and goodwill of the consumer and the supplier. Only when demand has been rationalized may we expect a net benefit from shortening length of stay.