HIPE & NPRS Unit, The Economic and Social Research Institute
This report presents the first comprehensive analysis of the five and a half million discharges treated by acute public hospitals in Ireland through the 1990’s. At the launch of this report, Professor Miriam Wiley from the ESRI said that “between 1990 and 1999 an increasing number of sicker people have been treated with shortening hospital stays within the acute hospital system”. As close to 800,000 discharges were treated in 1999, this represents an increase of over 40 per cent in the number of discharges treated since 1990. Much of the increase in activity may be attributed to reductions in length of inpatient stays and in the expansion of day beds in hospitals which has resulted in increased use of day services. In 1999, one third of all discharges were treated on a day basis compared with just over one in ten discharges in 1990.
Even though acute inpatients are now sicker, they are spending less time in hospital as average length of stay has dropped by half a day over the period to 5.1 days in 1999. This varies by hospital type though, as acute inpatients in voluntary hospitals are in hospital for around 6 days, on average, which is over one day longer than the average stay for acute inpatients in regional or county hospitals. By contrast, while voluntary hospitals account for just one third of all day hospital beds they treat over 40 per cent of all day cases. The regional and county hospitals combined treat close to half of all day cases while accounting for around 45 per cent of day beds.
The increased number of patients now being treated within shortened hospital stays are also sicker than those going through the acute hospital system in the early 1990s. By 1999 around 2.4 diagnoses, on average, were being reported per discharge which is a 50 per cent increase on the average number of diagnoses per discharge reported in the early 1990’s. In 1999, three out of every four discharges had a procedure performed compared with just over half of all discharges in 1990. While part of this increase may be attributed to the growth in the number of day patients who are more likely to have a procedure, there has been an increase to 1.6 in the average number of procedures delivered per discharge.
Just over one fifth of all discharges from Health Board hospitals are private patients compared with the Voluntary hospitals where one quarter of the discharges are private patients. For all of the Special hospitals combined, close to one in every three discharges was a private patient while just over one in every five discharges from the general hospitals fell within this category. While about 42 per cent of all discharges are medical card holders, this increases to about half of all discharges from county hospitals compared with about 39 per cent of discharges from voluntary hospitals. The distribution of discharges by public/private status also varies by Health Board as over one third of discharges from the Mid-Western Health Board were recorded as private compared with the North-Western Health Board where 18 per cent of discharges were classified as private.
Emergency admissions now account for over 70 per cent of all inpatient admissions with admissions from this source generally higher during the winter months. While the majority of elective admissions are now treated on a day basis, planned inpatient admissions are generally lower during the traditional holiday periods.
The majority of discharges were hospitalised in their health board of residence and where cross-boundary movement does occur, it is more likely to arise between neighbouring health boards. Notwithstanding the concentration of national specialties in the Eastern region, over 80 per cent of the patients treated in the Eastern Health Board were residents of that region whereas proportionately the largest inflow of patients from one health board to another in 1999 was reported for the Western Health Board where close to 7 per cent of discharges were residents of the Midland Health Board area.
For further information contact:
Professor Miriam Wiley, ESRI at (01) 667 1525, ext 460; mobile (087) 226 7787; email firstname.lastname@example.org.
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