- What is the composition of the patient population of general internal medicine (GIM) wards?
- To what degree can improving the care of patients in the community reduce the burden on GIM wards?
- Do hospitalization trends in Israel resemble those in other industrialized countries?
This report encompasses three papers that address these questions and others, and are aimed at gaining insight into the forces behind trends in hospitalization during the period spanning from 1965 to 1995. We believe that the presented observations are informative and relevant, even though they cover periods ending in 1995 or earlier, for the following reasons: First, they may provide insight into the changes that occurred during the same period of time. Second, we hope to update the data when additional information is made available by the Ministry of Health and the Central Bureau of Statistics, and thereby test the hypothesis generated in the present study.
The first paper describes the distribution of selected primary and secondary diagnoses among GIM in-patients. The second identifies across-country variations in the utilization of acute care hospitals in Israel and 21 other industrialized countries. The third describes the trends in hospitalization in Israel by age and by selected diagnoses.
Among the findings, it was shown that:
- There was an unexpectedly large proportion of primary diagnoses coded as “abnormal laboratory or ill-defined manifestations,” which may undermine the accuracy and completeness of diagnostic hospitalization statistics in Israel.
- Although the reason for most hospitalizations in GIM wards in 1995 was heart and respiratory disease, almost all diagnoses were represented, meaning that these wards offer a valuable learning environment for medical students.
- From 1976 to 1995, there was an increase in the number of discharges per 1,000 population. This trend was noted in other industrialized countries, although not all. In Israel, the steepest rise in the rate of discharges was among those aged 75+. The rate was not uniform for all diagnoses, and the reason for the variance in trends of hospitalization for elderly persons with different diagnoses is unclear. This finding opens various approaches to improvement of care. We should ask why elderly persons are being admitted to hospitals at increasing rates, and we should ask what makes specific diseases a cause for their increasing rates of hospitalization.
This study was conducted in the framework of the Cooperative Program in Health Policy Research of the Government of Israel and the JDC-Brookdale Institute, with funding from the National Institute for Health Policy and Health Services, and the Ben-Gurion University of the Negev.