International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery

Objecti es: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in healthcare system characteristics. Methods: Questionnaires were sent to experts in 12 countries in Northwest Europe. The questionnaire contained questions about the organization and diffusion of day case surgery (at country level and individually for 18 selected procedures), and relevant healthcare system characteristics (financing systems, organization of after care, etc.). Results: It is demonstrated that hospital bed supply relates to the diffusion of day surgery. In countries with fewer beds, a higher day surgery rate is found. The financing system of hospitals does not influence the choice of surgical setting. In countries with a fee-for-service financing system for hospital-based physicians, day surgery rates are not higher than in countries with salaried medical specialists. With respect to aftercare, the availability of sufficient home nurses favours day surgery. Conclusions: The relative scarcity of hospital beds or large reductions in bed supply has led to the perception of day surgery as an alternative that could meet the growing demand for surgical treatment. It is worthy of note that, although the majority of experts state that financial incentives discourage day surgery, the supply is growing. © 2001 Elsevier Science B.V. All