The hospital as an economic agent
This chapter focuses on the hospital sector. The rationale for a separate chapter on this subject is simple: the hospital is the major consumer of health care expenditures in all developed economies. In 1981 this sector alone accounted for 58 per cent of gross health care expenditure in the UK. Comparable percentages are 49.5 per cent for the USA (1983), 54.0 per cent for Australia (1981), 55.1 per cent for Canada (1982), 58.7 per cent for the Netherlands (1983) (OECD, 1985). The picture is similar from wherever the snapshot is taken. Given the labour intensive nature of health care it is also not surprising that the sector is a large employer. For example in 1951 the UK hospital sector employed just over 400, 000 people rising to more than a million by 1983. However, against this must be recorded the fact that the number of hospital beds per 1,000 population in the UK has been falling from 10.8 to 8.0 over the same period, as has the number of average daily occupied beds-from 472,000 to 356,000. Countering the fall in the level of resources used, there has also been a more intensive use of these resources in the UK-for example, deaths and discharges per available bed have risen from 7 to 16 in 1981. Similar trends are evident in other developed countries.