Patterns of Hospital Care and Physician Perspectives from an Italian,Japanese,and USA Hospital

Abstract

Many studies have compared different countries' health care systems at the macro level. Less has been done to analyze care provided for patients with specific diseases and to compare physician attitudes concerning factors that influence patient care. This study compares severity of illness and length of hospital stay for pa tients admitted for diabetes mellitus, cholecystitis, or appendicitis at three teaching hospitals in Italy, Japan, and the United States. Physicians caring for patients with these diseases were surveyed to assess their opin ions of the adequacy of resources available at their hos pital, perceived administrative pressures concerning re source use, and interactions with patients and their families that relate to admission and discharge deci sions. The severity of the patient mix was consistently higher in the U.S. hospital than in the Italian or Japa nese hospitals. Controlling for diagnosis, severity of ill ness, surgery, age, and presence of co-morbid condi tions, the U.S. hospital consistently had the shortest stays and the Japanese hospital the longest. Japanese physicians were more likely than U.S. or Italian physi cians to report insufficient resources, such as nurses, to provide quality care, but less likely to report adminis trative pressures interfering with patient care. Differ ences in hospital utilization may reflect variation in clinical practices, availability of resources, barriers to access to care, organizational differences at the na tional and hospital level, and patient and family preferences.