Hospital discharges and length of stay statistics
- Data extracted in September 2017. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: September 2018.
This article presents an overview of European Union (EU) statistics related to the number and rate of hospital discharges and the average length of stay for patients in hospitals. It provides information relating to hospital discharges of in-patients and day care patients, providing analyses by the age and gender of patients and their diagnoses; this may be used as an indicator for the level of healthcare activity in hospitals. A similar collection of analyses is presented for the average length of stay for in-patients.
This article is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.
- 1 Main statistical findings
- 2 Data sources and availability
- 3 Context
- 4 See also
- 5 Further Eurostat information
- 6 External links
Main statistical findings
A hospital discharge occurs when a hospital patient is formally released after an episode of care. The reasons for discharge include finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death. The data should cover all types of hospitals, including general hospitals, mental health hospitals and other specialised hospitals, as well as all types of diagnosis and treatment, including discharges of healthy new-borns. In practice, data availability is more limited in some national statistics: a summary of the main deviations from the standard coverage is provided in the Data sources and availability section below. In cases where national statistics exclude any types of hospitals this will understate, to a greater or lesser extent, the number and rate of discharges. This is particularly true for certain types of diagnoses if the exclusions are related specialisations, for example, the exclusion of psychiatric hospitals or mental health care institutions impacts on the data for discharges of patients diagnosed with mental and behavioural disorders.
Ireland, the United Kingdom, Portugal and Belgium reported more day care patients than in-patients
Among the 24 EU Member States for which recent data are available for in-patients and day care patients, only Ireland, the United Kingdom Portugal and Belgium (2014 data) reported more discharges of day care patients than in-patients in 2015. By contrast, there were around 10 times as many in-patient discharges as discharges of day care patients in Lithuania and Sweden and this ratio reached a level between 29 and 37 times as high in the Czech Republic and Germany.
Relative to population size, discharge rates in 2015 for in-patients were generally in the range 10.2-20.7 thousand per 100 000 inhabitants for most EU Member States (see Figure 1); Lithuania, Germany, Austria and Bulgaria reported higher rates (23.1-31.5 thousand per 100 000 inhabitants); Portugal and Cyprus reported rates that were below 8.0 thousand per 100 000 inhabitants. Comparing the highest and lowest values, the in-patient discharge rate in Bulgaria was 4.5 times as high as in Cyprus.
Turning to day care patients (see Figure 2), relative to population size, discharge rates among the EU Member States in 2015 were generally in the range 1.4-13.0 thousand per 100 000 inhabitants. Belgium (2014 data) and the United Kingdom reported rates that were somewhat higher (15.9 and 16.6 thousand per 100 000 inhabitants), while Ireland reported the highest rate (20.8 thousand per 100 000 inhabitants; 2014 data). Germany and the Czech Republic reported much lower rates than the other Member States, at 677 and 666 day care discharges per 100 000 inhabitants respectively.
The highest discharge rates for all hospitalised patients were in Ireland, Romania, Austria and Belgium
Combining discharge rates in 2015 for in-patients and day care patients, the highest discharge rates for all hospitalised patients were in Ireland (2014 data), Romania, Austria and Belgium (2014 data) which were the only EU Member States with rates over 30 thousand per 100 000 inhabitants, while the lowest discharge rate was in Cyprus with a rate of 8.5 thousand per 100 000 inhabitants.
Between 2010 and 2015, discharge rates for in-patients decreased for a small majority of the EU Member States. The highest relative increases were registered in Bulgaria and Malta. By contrast, nearly all EU Member States reported increased discharge rates for day care patients during this period, the exceptions being Sweden, Finland, Portugal, Slovenia and Italy.
Less discharges of male patients than of female patients in nearly all EU Member States
Among the EU Member States for which data are available, in all but one — Cyprus — there were more discharges of female in-patients than male in-patients, as was also the case in the non-member countries shown in Figure 3. For day care patients, Cyprus and Germany reported more discharges of male patients than female patients.
Tables 1 and 2 provide an analysis of discharge rates in 2015 by age, distinguishing male and female patients, as well as in-patients and day care patients. Among in-patients, discharge rates for infants aged less than one year exceeded 100 000 per 100 000 inhabitants in most EU Member States that include discharges of all healthy new-borns in their data; the only exceptions were the United Kingdom, Denmark (2014 data), Spain, Austria and Finland for males and females, as well as Portugal just for females. Rates below this level indicate a proportion of births taking place as day care procedures (see for example the relatively high day care discharge rate for infants aged less than one year in the United Kingdom), as home births, or as births in institutions outside the data coverage.
Among the EU Member States that do not provide data for discharges of healthy new-borns, in-patient discharge rates for infants aged less than one year were generally less than 45 thousand per 100 000 inhabitants. In most of the Member States including healthy new-borns in their discharge rates, the highest rates were recorded in the age group for infants aged less than one year; the only exceptions were Denmark (2014 data), Spain, Austria and Finland where the highest discharge rates were recorded for older age groups.
Different age pattern to in-patient discharge rates for males and females, mainly characterised by high discharge rates for women in the typical child-bearing age range
Leaving aside the youngest age group and focusing on discharge rates of in-patients aged one year or over there were clearly different age patterns for males and females. For males, in-patient discharge rates generally fell from higher rates among very young males, to lows among men aged in their teens, 20s and early 30s, before rising again to peak amongst the oldest age groups. For females the in-patient discharge rates also fell from high rates among the youngest girls to low rates among girls in their early teens. In-patient discharge rates for women then increased again from the late teens to a peak for women in their early thirties before dropping back down to a relatively low rate for women in their early forties. This increase and subsequent decrease is focused in the typical age groups for child-bearing. From their early forties, in-patient discharge rates for women rose again through to old age.
Discharge rates for day care patients generally peaked among women aged 65-79 and among men aged 80 and over
While for in-patients the highest discharge rates were normally recorded for infants aged less than one year, for day care patients this was only the case in Denmark, Germany and Sweden for males and females, and Croatia just for females. In fact, a small number of EU Member States recorded their lowest discharge rates for day care patients among infants aged less than one year: Malta just for males, Belgium (2014 data), Latvia (2014 data), Austria and Slovenia just for females, and Spain, France, Luxembourg, Hungary and Portugal for males and females.
For males, day care discharge rates generally fell from high rate for infants aged less than one year through to their lowest level for the age group 20-24 or 25-29, and then gradually increased to their highest level for the age group 75-79. The exceptions to this pattern were mainly EU Member States where the highest rates were recorded in another age group among older people (such as 70-74 or 80-84) or among infants aged less than 1, or where the lowest rates were recorded among children, for example among males aged 10-14.
For females, the pattern was somewhat different. The lowest rates for females were most often recorded in the youngest age groups, particularly aged 5-9 and 10-14. Atypically, the lowest rates were recorded for the age groups 15-19 or 20-24 in Cyprus, Latvia and Poland, and for the age group 95 and over in the Czech Republic, Croatia, Italy, Lithuania and Romania. There was an almost universal pattern for day care discharge rates to rise again for females from the age group 15-19. In line with what was observed for men, day care discharge rates peaked for the age group 75-79 in most EU Member States before dipping back down for the older age groups A small number of Member States recorded their highest day care discharge rates for women among other age groups, typically for infants aged less than 1, for the age groups 65-69 or 70-74 years, or, as was the case in the Czech Republic and Slovenia, for the age group 30-34.
Discharges by diagnosis — as presented in Tables 3 and 4 — refer to the principal diagnosis, in other words, the main condition diagnosed at the end of the hospitalisation. The main condition is the one primarily responsible for the patient’s need for treatment or investigation.
In nearly all EU Member States circulatory diseases were the most common main diagnosis for in-patients
For in-patients, the main diagnosis in 2015 across EU Member States was circulatory diseases. The rare exceptions to this were: Ireland where pregnancy and childbirth was the most common; and the United Kingdom where diseases of the respiratory system were the most common. Across all of the Member States other diagnoses that were also common included diseases of the digestive system, neoplasms (benign or malignant cancers), diseases of the respiratory system, injuries and other external causes, as well as pregnancy and childbirth.
The most common main diagnoses for day care patients were neoplasm, and diseases of the digestive or genitourinary systems
For day care patients, the most common main diagnosis was less clear cut, with a majority of the EU Member States reporting their highest discharge rates for either neoplasms or for diseases of the genitourinary system, reflecting the use of day care for some cancer treatments (such as chemotherapy) and some kidney disease treatments (such as dialysis). Other common diagnoses included: diseases of the digestive system in Belgium (2014 data), Ireland, France and Malta; diseases of the musculoskeletal system and connective tissue in Luxembourg; diseases of the circulatory system in Denmark, Germany and Sweden; injuries and other external causes in Poland and Finland .
Average length of hospital stay for in-patients
The average length of stay for in-patients is calculated from the total number of nights spent in hospitals by in-patients divided by the total number of discharges. As such, the average length of stay may be less influenced by coverage issues (insofar as the average length of stay in the institutions excluded from the coverage can be assumed to be similar to that in the institutions that are covered). This is clearly not the case when only acute care institutions are covered but not those providing long-term care and in these cases the average length of stay is likely to be underestimated. By contrast, the exclusion of discharges of healthy new-borns from some national data is likely to over-estimate the overall average length of stay, as the average length of stay for healthy new-borns is typically lower than the average length of stay for all other diagnoses combined. A summary of the main deviations from the standard coverage is provided in the Data sources and availability section below and highlights those national statistics where some of these issues can be found.
The average length of hospital stays fell in most EU Member States during the five years between 2010 and 2015
In 2015 (or latest year), the average length of a hospital stay for in-patients ranged from 5.3 days in Bulgaria to 9.5 days in Hungary, with Finland above this range with an average of 10.5 days.
Comparing the average length of stay in 2015 (or latest year — see Figure 5) with the situation in 2010, a large majority of the EU Member States observed a reduction in the average length of time that patients spent in hospital, most notably in Finland, the Czech Republic and Bulgaria. By contrast, five Member States recorded an increase during this period: Malta, Portugal, Italy, Romania and Cyprus (2011-2015).
Males generally spent longer than females in hospital …
Although there were generally more female in-patients than male in-patients (see Figure 3), the average length of stay for male in-patients in 2015 was generally longer in most of the EU Member States. The main exceptions to this pattern, as can be seen from Figure 6, were Hungary, Finland and Belgium (2014 data) where female in-patients recorded clearly longer hospital stays, while in Austria the average for female patients was only slightly higher than for male patients and in Malta and Germany they were the same.
… while the average length of in-patient stays tended to be shortest for children aged 1-9 and highest for people aged 85 or over
A detailed age group analysis of the average length of in-patient hospitals stays is presented in Table 5. The average length of stay was generally lower for young children aged 1-4 or 5-9 than it was for the youngest age group, in other words infants aged less than one year. Between the age groups 5-9 and 10-14 there was an increase in the average length of stay in all EU Member States, but the average then remained relatively stable through to the age group 30-34. Thereafter, the average length of in-patient stays increased through to the age group 50-54 after which it again stabilised through to the age group 65-69. From the age group 70-74 upwards the average length of stay tended to get higher with each age group until it peaked in most Member States in one of the higher age groups, specifically 85-89, 90-94, or 95 and over. In Germany, Croatia and Latvia, the longest average stays were recorded for the age groups 45-49, 50-54 and/or 55-59; for Cyprus and Sweden (2014 data) it was for infants aged less than one year; Hungary had the biggest difference in average length of stay between the age groups, with an average of 3.5 days for children aged 1-4 rising up to an average of 34.9 days for people aged 95 and over.
In-patients with mental and behavioural disorders generally spent the longest time in hospital per stay
Among the nine diagnoses presented in Table 6, the average length of stay for in-patients was notably longer for mental and behavioural disorders. France was the only EU Member State where there was a longer average length of stay for another diagnosis, reflecting a particularly low average length of stay for mental and behavioural disorders; note that in several Member States (including France), the data presented in Table 6 exclude discharges from some or all psychiatric hospitals or mental health care institutions. The longest average stays for in-patients with mental and behavioural disorders were reported for Malta, the Czech Republic and the United Kingdom, between 38 and 47 days. Among the other diagnoses, the average lengths of stay were generally highest for patients being diagnosed or receiving treatment for diseases of the circulatory system or neoplasms.
For several of the diagnoses shown in Table 6 there was a relatively high degree of uniformity in the average length of stay reported by each EU Member State. For example, in-patients diagnosed with diseases of the digestive system spent on average between 4.4 days (in Bulgaria and in Sweden) and 6.8 days (in Croatia) in hospital; patients diagnosed with diseases of the respiratory system and those diagnosed with diseases of the genitourinary system also reported quite similar average lengths of stay across the Member States. By contrast, for diseases of the circulatory system the average length of stay for in-patients ranged from 4.2 days in Bulgaria to 12.4 days in Hungary. For mental and behavioural disorders the average length of stay varied even more, although this is influenced to some extent by the fact that patients in some or all psychiatric hospitals or mental health care institutions are excluded in several Member States.
Data sources and availability
An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for diagnosis, treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care.
In contrast to in-patient care, the intention for day care is to discharge the patient on the same day as admitted. In contrast to outpatient care, day care comprises planned medical and paramedical services delivered to patients who have been formally admitted for diagnosis, treatment or other types of health care.
An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.
The average length of stay of in-patients in hospitals is computed by first calculating the number of hospital days (or bed-days or in-patient days) from the date of admission to an in-patient institution as the date of discharge minus date of admission, and then dividing this by the number of discharges during the year.
Healthcare resources and activities
Statistics on healthcare activities such as information on discharges and average length of stay are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
For country specific notes on this data collection, please refer to this background information document. Data do not always cover all hospitals, treatments or types of patients. The main exceptions noted for 2015 data (or the latest available year when 2015 data are not available) by EU Member States and non-member countries are listed below.
|Types of institutions||Main exception(s)|
|Belgium and France||Excludes long-stay hospitals (covers only acute care hospitals) and psychiatric/mental health hospitals|
|Serbia||Excludes private hospitals, prison hospitals and military hospitals|
|Norway||Excludes private hospitals|
|Germany||Excludes prevention and rehabilitation facilities with less than 100 beds|
|Ireland||Excludes private hospitals, long-stay hospitals (covers only acute care hospitals) and psychiatric/mental health hospitals|
|Spain||Excludes psychiatric and long-stay hospitals unless they form a hospital complex|
|Switzerland||Excludes prison and military hospitals|
|Croatia and Latvia||Excludes prison hospitals|
|Italy and Poland||Excludes military hospitals|
|Cyprus||Excludes private hospitals and psychiatric/mental health hospitals|
|The Netherlands||Excludes private and semi-private hospitals, mental health and substance abuse hospitals, epilepsy clinics and long-stay hospitals (covers only acute care hospitals)|
|Portugal||Excludes hospitals not on the mainland and private hospitals|
|Slovenia and Iceland||Excludes rehabilitative care in specialised centres|
|The United Kingdom||Excludes private hospitals except insofar as they are providing services commissioned by the public sector (national health service)|
|Types of activity / treatment||Main exception(s)|
|Estonia, Ireland, Cyprus, Latvia and Luxembourg||Excludes some or all healthy babies born in hospitals|
|The Netherlands||Excludes part-time psychiatric treatments in general or university hospitals with a psychiatric ward; rehabilitation day-treatment; day care admissions for normal deliveries of babies|
|Types of patient||Main exception(s)|
|France and Luxembourg||Excludes non-residents|
|Belgium (184 days), Italy (365 days) and Slovakia (700 days)||Excludes long-term patients|
The main diagnosis for discharges is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). The diagnoses presented in this article include:
- C00-D48 Neoplasms
- F00-F99 Mental and behavioural disorders
- I00-I99 Diseases of the circulatory system
- J00-J99 Diseases of the respiratory system
- K00-K93 Diseases of the digestive system
- M00-M99 Diseases of the musculo-skeletal system and connective tissue
- N00-N99 Diseases of the genitourinary system
- O00-O99 Pregnancy, childbirth and the puerperium
- S00-T98 Injury, poisoning and certain other consequences of external causes
Note on tables: the symbol ':' is used to show where data are not available.
Statistics on hospital discharges and the average length of hospital stays reflect the balance between the demand for and supply of hospital services. They represent how many patients were actually admitted (as in-patients or day care patients) and how long they were treated; they can be complemented by other supply side statistics such as occupancy rates (see an article on hospital beds), the frequency of operations and procedures, healthcare expenditure, as well as demand side statistics (see the article on unmet medical needs).
The balance between in-patient and day care patient discharges, as well as the number of out-patients and the average length of hospital stays, reflect a number of factors, including:
- demographic changes such as an ageing population which pushes up demand for hospital services;
- budgetary pressures to keep costs down; and
- changes in practices and technology impacting on the length of acute care and/or the balance between in-patient care, day care and outpatient care.
The European core health indicators (ECHI) shortlist includes indicators on hospital in-patient discharges, hospital day cases and average length of stay in the chapter on health services.
Healthcare activities and expenditure
- Surgical operations and procedures
- Unmet needs for health care
- Healthcare expenditure
General health statistics articles
Further Eurostat information
- Health care (t_hlth_care)
- Health care (hlth_care)
- Health care activities (hlth_act)
- Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)
- Hospital discharges - National data (hlth_hosd)
- Hospital discharges by diagnosis, in-patients, total number (hlth_co_disch1)
- Hospital discharges by diagnosis, in-patients, per 100 000 inhabitants (hlth_co_disch2)
- Hospital discharges by diagnosis, day cases, total number (hlth_co_disch3)
- Hospital discharges by diagnosis, day cases, per 100 000 inhabitants (hlth_co_disch4)
- Length of stay in hospital (hlth_hostay)
- In-patient average length of stay (days) (hlth_co_inpst)
- Health care activities (hlth_act)
Methodology / Metadata
- Healthcare resources (ESMS metadata file — hlth_res_esms)
Source data for tables and figures (MS Excel)
- European Commission — Directorate-General for Health and Food Safety — European core health indicators (ECHI)
- European Commission — Directorate-General for Health and Food Safety — Health systems performance assessment
- European Commission — Directorate-General for Health and Food Safety — Public health
- OECD — Health policies and data
- WHO Global Health Observatory (GHO)
- World Health Organisation (WHO) — Health systems