Variations between and within countries in hospital care for peptic ulcer. A comparison between Denmark and Sweden

The present study tries to examine variations in utilization rates for hospital care for ulcer disease between and within Denmark and Sweden. The focus is on how utilization rates differ but an attempt is also made to explain why regional differences occur. Hospital patient statistics from both countries show that ulcer disease accounts for 35% more bed-days per 100000 inhabitants in Denmark than in Sweden. The main source for this difference is duodenal ulcer, where the number of bed-days is 63% higher in Denmark. The differences in length of stay are negligible and the numbers of surgical operations are about the same in the two countries. The greater utilization of hospital resources in Denmark is explained mainly by the fact that more medical cases are treated as in-patients in Denmark than in Sweden. Neither mortality rates nor other data support the hypothesis that the incidence of duodenal ulcer is higher in Denmark than in Sweden. The difference between Denmark and Sweden widens when utilization rates are adjusted for differences in the age structure of the population in the two countries. There are wide variations in utilization rates between regions within both countries. The findings support the hypothesis that the intertemporal change in the technology for management of ulcer disease is one of the main reasons for variations between and within countries.