The status of hospital discharge data in Denmark, Scotland, West Germany, and the United States.

This section has surveyed characteristics of the health service systems in Denmark, Scotland, West Germany, and the United States. Certain characteristics in each country are likely to increase hospital utilization. In the United States the characteristics include economic incentives to physicians and patients for hospital use and the high percent of physicians in specialty practices. In Denmark the high proportion of hospital-based physicians may increase hospital use. In Scotland the use of capitation to pay office-based physicians and the absence of a nursing home system probably increase hospital use, and in West Germany the large number of physicians per population and the lack of sufficient alternative facilities for long-term care are likely to increase hospital use. On the other hand, each health services system has some characteristics that should decrease hospital use: for instance, the large number of alternative facilities for long-term care in the United States, the well-established programs for home care in Denmark and Scotland, and the small percent of physicians who are specialists in West Germany. Further research is needed to understand the interactions of these factors and the effects they have on hospital use. Increased understanding of the effects of health services system characteristics should result in more useful comparisons of hospital utilization statistics.