Aug 2017

Understanding the Average Length of Stay in Hospitals

Published in General on August 31, 2017

Frequently regarded as a sign of efficiency, the average length of stay in hospitals (ALOS) has a direct correlation with how much people are spending. A shorter ALOS, assuming all other factors are the same, will reduce the average cost of each discharge. This also means patients need to rely more on post-acute services. In addition, a shorter hospital stay usually means more intense treatment, which comes at a higher overall cost. Shortening the length of stay may have some adverse effects on healthcare, such as less comfort and a longer recovery time for patients. If the care received is inefficient, then the patient may need to be readmitted, causing the cost per illness to rise.

In 2013, the ALOS for hospitals in OECD countries was about eight days (Figure 6.13). The shortest times internationally were seen in Turkey and Mexico, with an average of about four days. Countries like Japan and Korea promoted significantly longer stays, often over 16 days. As a whole, the ALOS has fallen from 10 days in 2000 to about eight days in 2013, with very few exceptions. Hungary, Luxembourg and Korea have increasing lengths of stay, well above the average.

Considering the average length of stay based on illnesses and diseases shows more unified results. (Figure 6.14) Normal care in hospitals typically lasted for three days in 2013. This is a sharp decrease from 2000. The lowest countries saw an average of less than two days. These countries included Canada, the United Kingdom, Mexico, New Zealand, the Netherlands, Turkey and Iceland. Only a few countries reached five or more days. These countries included Hungary and the Slovak Republic.

Patients suffering from acute myocardial infarction received care for seven days on average in 2013. While Nordic countries continued to produce shorter ALOS, countries like Korea and Germany showed significantly increased times (Figure 6.15).

While the differences could lie in the patient’s condition, culture often plays a more significant role. Each country has its own clinical practices and payment systems, which reflects the overall structure of the hospital system. Several countries, including France, Poland and Germany, charge patients based on their diagnosis. These diagnosis-related groups (DRGs) often have reduced hospital stays. Switzerland is a prime example, as they moved from per diem payments to a DRGs system in 2011, subsequently lowering their ALOS.

The majority of countries seeing longer ALOS times are also increasing their overall quality of care.  Reducing the number of available hospital beds and increasing outpatient community care services can help to counteract this. In Denmark, recent healthcare reforms encourage high-quality treatments in healthcare (OECD, 2013). They also promote more non-surgical procedures, early discharge programs, and streamlined payment methods. This enables patients to receive follow-up care at their own pace without visiting the hospital.

Comparing Average Lengths of Stay

The number of days the average person spends in the hospital is defined as “average length of stay” or ALOS. To reach this number, statistics are gathered from all patients throughout the year. Those who simply visit the hospital aren’t included in the final numbers, only people who receive overnight treatments. The data covers all curative and acute care cases with very few exceptions. Countries like Japan, the Netherlands and Canada provide estimations. Other countries tend to overestimate the ALOS because they don’t include the length of stay data for healthy babies. For example, including healthy newborns in Canadian ALOS statistics would result in a reduction of 0.5 days.