A Comparison of Western European and US University Hospitals: Title and subTitle BreakA Case Report From Leuven, West Berlin, Leiden, London, and San Francisco FREE

Steven A. Schroeder, MD

[+] Author Affiliations

Reprint requests to Division of General Internal Medicine, 400 Parnassus Ave, A-405, University of California, San Francisco, CA 94143 (Dr Schroeder).

JAMA. 1984;252(2):240-246. doi:10.1001/jama.1984.03350020042023

Text Size: A A A

Published online

Article

References

ABSTRACT

ABSTRACT | REFERENCES

To assess how closely US university hospitals resemble those in other Western countries, I compared four major European university hospitals— Leuven, Belgium; Klinikum Steglitz, West Berlin; Leiden, the Netherlands; and St Thomas', London—with a US institution—University of California, San Francisco (UCSF). University of California had 1.6 to 2.4 more total employees, 1.1 to 1.7 more registered nurses, 2.1 to 8.5 more staff physicians, and 1.5 to 3.0 more house officers per adjusted occupied bed. University of California's costs per bed were 2.2 to 3.5 times higher, its inclusive per diem charges at least four times higher, and its malpractice premium at least 50 times greater. Medical patients at UCSF and West Berlin were more severely ill, as judged by organ system failure, need for organ system support, and levels of consciousness. Compared with UCSF, the European hospitals had more explicit rationing of care according to age and illness severity. Overall, European university hospitals are larger, less expensive, less technology intensive, staffed by fewer employees and physicians, occupied by less severely ill patients, and more apt to serve as regional referral centers. As US university hospitals move into a price-competitive era, they may come to resemble their European counterparts.

(JAMA 1984;252:240-246)

REFERENCES

ABSTRACT | REFERENCES

Iglehart JK: Moment of truth for the teaching hospitals . N Engl J Med 1982;;307:132-136.

Ebert RH, Brown SS: Academic health centers . N Engl J Med 1983;;308:1200-1208.

Rogers DE, Blendon RJ: The academic medical center: A stressed American institution . N Engl J Med 1978;;298:940-950.

Schroeder SA: Medical technology and academic medicine: The doctor-producer's dilemma . J Med Educ 1981;;56:634-639.

Summary Report of the Graduate Medical Education Advisory Committee to the Secretary, Department of Health and Human Services , Dept of Health and Human Services publication (HRA)81-656. Health Resources Administration, (Sept 30) , 1980;.

Maynard A: Health Care in the European Community . Pittsburgh, University of Pittsburgh Press, 1975;.

McLachlan G, Maynard A (eds): The Public/Private Mix for Health . London, The Nuffield Provincial Hospitals Trust, 1982;.

Glaser WA: Health Insurance Bargaining: Foreign Lessons for Americans . New York, Gardner Press Inc, 1978;.

Glaser WA: Paying the Doctor: Systems of Remuneration and Their Effects . Baltimore, The Johns Hopkins Press, 1970;.

Banta HD, Kemp KB: Background Paper No. 4: The Management of Health Care Technology in Ten Countries . Washington, DC, Office of Technology Assessment, 1980;.

Schroeder SA: Western European responses to physician oversupply: Lessons for the United States . JAMA , in press.

Isaacs JC: COTH Survey of University Owned Teaching Hospitals' Financial and General Operating Data . Washington, DC, Association of American Medical Colleges, (June) 1983;.

Butler PW, Bentley JD, Knapp RM: Today's teaching hospitals: Old stereotypes and new realities . Ann Intern Med 1980;;93:614-618.

Myers LP, Schroeder SA, Chapman SA, et al: What's so special about special care? The definition, genesis, cost and impact of special care units . Inquiry , in press.

Showstack JA, Schroeder SA, Matsumoto M: Changes in the use of medical technologies, 1972-1977: A study of ten inpatient diagnoses . N Engl J Med 1982;;306:706-712.

Rabkin MT: The SAG index . N Engl J Med 1982;;307:1950-1951.

Fitzgerald FT: From Galen to Xerox: The authoritarian reference in medicine . Ann Intern Med 1982;;96:245-246.

Evans RW: Health care technology and the inevitability of resource allocation and rationing decision . JAMA 1983;;249:2047-2053, 2208-2219.

Bayer R, Callahan D, Fletcher J, et al: The care of the terminally ill: Morality and economics . N Engl J Med 1983;;309:1490-1494.

Myers LP, Schroeder SA: Physician use of services for the hospitalized patient: A review with implications for cost containment . Milbank Mem Fund Q 1981;;59:481-507.

McPhee SM, Myers LP, Schroeder SA: The costs and risks of medical care: An annotated bibliography for clinicians and educators . West J Med 1982;;137:145-161.

Schroeder SA, Myers LP, McPhee SJ, et al: Educational strategies to limit expenditures at a university hospital: Report of a prospective controlled trial . JAMA 1984;;252:225-230.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal