Future hospital trends in New Zealand

The acute public hospital is the most visible part of the public health system, and also the most expensive. As Malcolm shows in this issue of the Journal,1 New Zealand has made remarkable strides in improving the efficiency of hospital care. Clear evidence of the gains made in New Zealand over the past 17 years is shown—average length of stay (ALOS) has halved, inpatient admission rates held steady, and bed numbers per 1000 population significantly reduced. The New Zealand public system now seems more efficient than the Australian and English systems. Whether comparing the ALOS (3.9 days vs 6.1 in Australia, 5.0 in England), discharge rates per 1000 population (157 vs 341 and 200) or hospital beds per 1000 population (2.0 vs 4.0 and 3.4), New Zealand is well ahead. It is difficult enough making comparisons between DHBs let alone between countries, but the Australian and UK systems bear very close similarities to our own. Malcolm also compares to Kaiser in the USA. This is more problematic—North American systems treat ambulatory care in quite a different way, and the absence of full population coverage make comparisons a little lop-sided