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 European countries (e.g., Denmark, Italy, Netherlands, Norway, Portugal, Slovak Republic, Spain and the United Kingdom), patients are required or even incentivised to first consult a general practitioner (GP) about any new episode of illness. The GP may then refer them on 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 imaging 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 measurement of the resources available for delivering services to inpatients in hospitals. This section presents data on the number of overall hospital beds in 2000 and 2015 and for different types of care (curative care, rehabilitative care, long-term care and other functions). It also presents an indicator of bed occupancy rates over time, 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 is often regarded as an indicator of efficiency. All else being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. Longer stays can be indicative of poor-value care: inefficient hospital processes may cause delays in providing treatment; errors and poor-quality care may mean patients need further treatment or recovery time; poor care co-ordination may leave people stuck in hospital waiting for ongoing care to be arranged. At the same time, some people may be discharged too early, when staying in hospital longer could have improved their outcomes or reduced chances of re-admission.

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 and hip fractures, reducing pain and disability and restoring some patients to near normal function.

Rates of caesarean delivery have increased over time 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 increasing preference of some women to have a caesarean delivery. 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 deliveries that may not be medically required.

In the past few decades, the number of surgical procedures carried out on a same-day basis has markedly increased in OECD countries. Advances in medical technologies – in particular 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 overall health spending may not be straightforward since the reduction in unit cost (compared to inpatient surgery), may be offset by the overall 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.