Hospital discharges and length of stay statistics

Data extracted in August 2020.

Planned article update: September 2021.

Highlights

In 2018, France recorded the highest discharge rate for all hospitalised patients (42 919 per 100 000 inhabitants for in-patients and day care patients) among the EU Member States.

Circulatory diseases were the most common main diagnosis for in-patients in 2018 in most of the EU Member States; however, this was not the case in Ireland, Spain, Cyprus or Luxembourg.

In 2018, in-patients in Hungary (9.9) and Czechia (9.6) spent the longest average number of days in hospital.

Average length of stay for hospital in-patients, 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 for 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.

Full article

Hospital discharges

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. For reasons of comparability, discharges of healthy new-borns have been excluded from the data presented in this article.

In practice, data availability is more limited in some national statistics and a summary of the main deviations from the standard coverage is provided in the Data sources 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, France, Croatia, Belgium and Portugal reported more day care patients than in-patients

Among the 25 EU Member States for which recent data are available for in-patients and day care patients (incomplete data for Bulgaria and Greece), only Ireland, France, Croatia, Belgium and Portugal (2015 data) reported more discharges of day care patients than in-patients in 2018. 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 28 and 37 times as high in Czechia, Slovakia and Germany (2017 data).

Relative to population size, discharge rates in 2018 for in-patients were in the range of 10 400 to 18 600 per 100 000 inhabitants for most EU Member States (see Figure 1); Romania, Lithuania, Austria, Germany (2017 data) and most notably Bulgaria (33 600 per 100 000 inhabitants) reported higher rates; the Netherlands and Cyprus (7 900 per 100 000 inhabitants) reported the lowest rates. Comparing the highest and lowest values, the in-patient discharge rate in Bulgaria was 4.2 times as high as in Cyprus.

Figure 1: Hospital discharges, in-patients, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

Turning to discharges of day care patients relative to population size (see Figure 2), the discharge rates among the EU Member States in 2018 were generally in the range of 1 200 to 9 800 per 100 000 inhabitants. Romania, Belgium, Croatia, Ireland and France reported rates that were higher (16 800 to 25 300 per 100 000 inhabitants). Czechia, Germany (2017 data) and Slovakia reported much lower rates than the other Member States, at 672, 669 and 537 day care discharges per 100 000 inhabitants respectively.

Figure 2: Hospital discharges, day care patients, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch4)

The highest discharge rate for all hospitalised patients was in France

Combining discharge rates in 2018 for in-patients and day care patients, the highest discharge rate for all hospitalised patients was in France (incomplete data for Bulgaria; no recent data for Greece), and had a rate of 42 900 per 100 000 inhabitants. Romania, Croatia, Ireland, Bulgaria (excluding day care patients), Belgium and Austria reported rates between 30 600 and 37 700 per 100 000 inhabitants, while all other Member States (for which data are available) reported rates below 25 500 per 100 000 inhabitants, with the lowest rate of all in Cyprus, 9 800 per 100 000 inhabitants.

Between 2013 and 2018, discharge rates for in-patients decreased for a majority of the EU Member States (16 out of 25; no comparison available for Greece or Portugal). The highest relative increases were registered in Bulgaria and France, while the biggest contractions were recorded in Italy, Estonia, Luxembourg (2013-2016), the Netherlands and Sweden. By contrast, a majority of the EU Member States (no comparison available for Bulgaria, Greece or Portugal) reported an increase in discharge rates for day care patients during the period from 2013 to 2018, the exceptions being Finland, Austria, Lithuania, Italy, the Netherlands and Sweden.

Hospital discharges by sex and age

Fewer discharges of male patients than of female patients in nearly all EU Member States

Among the EU Member States for which data are available (no data for Greece), in all but one — Cyprus — there were more discharges of female in-patients than male in-patients in 2018, as was also the case in most of the non-member countries shown in Figure 3, Montenegro and Liechtenstein being the only exceptions. For day care patients, Cyprus, France, Germany (2017 data) and Ireland reported more discharges of male patients than female patients.

Figure 3: Ratio of male to female hospital discharges, 2018
(ratio)
Source: Eurostat (hlth_co_disch1) and (hlth_co_disch3)

Tables 1 and 2 provide an analysis of discharge rates in 2018 by age, distinguishing male and female patients, as well as in-patients and day care patients. Due to space constraints only a selection of age ranges is shown, whereas the full set of data — available online — has been used for the following commentary.

Among in-patients, discharge rates were generally high for infants aged less than one year, then fell to a low between late teenage years or early adulthood for men, or later adulthood for women, before increasing again in old age. Discharge rates for infants aged less than one year exceeded 100 000 per 100 000 inhabitants in Estonia (2017 data) and Romania for both males and females and in Lithuania for males; note that these data do not include discharges of healthy new-borns. The lowest discharge rates for infants aged less than one year — below 20 000 per 100 000 inhabitants — were recorded in Portugal (2015 data) for males and females and in Luxembourg (2016 data) for females.

Table 1: Hospital discharges of in-patients, by age (selected age ranges) and by sex, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

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 lower rates among men in their teens, twenties and early thirties, 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 and late teens. In-patient discharge rates for women then increased again, to peak in women’s early thirties. Thereafter the discharge rates dropped back down to a relatively low rate for women in their early forties before increasing again in older age ranges in a similar manner to that observed for males, although with generally lower discharge rates for older females. The increase and subsequent decrease observed for females in early adult years is focused in the typical age ranges for child-bearing.

Discharge rates for day care patients quite similar for males and females

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 (2016 data), Slovakia and Sweden (no recent data or incomplete data for Bulgaria, Estonia and Greece). In fact, several EU Member States recorded their lowest discharge rates for day care patients among infants aged less than one year: Luxembourg (2016 data) just for females, and France, Latvia, Hungary, the Netherlands and Portugal (2015 data) for males and females.

Table 2: Hospital discharges of day care patients, by age (selected age ranges) and by sex, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch4)

For males, day care discharge rates for many EU Member States fell from a high rate for infants aged less than one year through to their lowest level for one of the age groups between 10-14 and 35-39 years, and then gradually increased to their highest level for the age group 75-79 years (or a slightly older or slightly younger age group). Some exceptions to this pattern included: Germany, where the highest day care discharge rates for males were recorded for the 95 years and over age group; as noted above, in France, Latvia, Hungary, the Netherlands and Portugal (2015 data), the lowest day care discharge rates for males were recorded among infants aged less than one year. Denmark, Slovakia and Sweden were also notable exceptions in that the day care discharge rates for older generations of males never passed those for infants aged less than one year (which therefore had the highest rates), while in Lithuania the highest day care discharge rate for males was for those aged 1-4 years.

For females, the pattern was somewhat different. The lowest day care discharge rates for females were most often recorded in some of the youngest age groups, particularly aged 5-9 years and 10-14 years, or even through to 20-24. Atypically, the lowest rates were recorded — as noted above — for infants aged less than one year in France, Latvia, Luxembourg (2016 data), Hungary, the Netherlands and Portugal (2015 data), and for the age group 95 years and over in Croatia, Italy, Lithuania and Romania. There was an almost universal pattern for day care discharge rates for females to rise again from the age group 15-19 years. In line with what was observed for men, day care discharge rates for females most commonly peaked for the age group 75-79 years (or a slightly older or slightly younger age group) 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 much younger age groups, for infants aged less than one year (Denmark (2016 data), Slovakia and Sweden) or for the age groups 30-34 years or 35-39 years (Czechia, Italy, Lithuania and Slovenia). Germany (2017 data) was a further exception, as its highest day care discharge rate for women was recorded for those aged 95 years and over.

Hospital discharges by diagnosis

Discharges by diagnosis — as presented in Tables 3 and 4 as well as Figure 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.

Table 3: Hospital discharges of in-patients, by disease/injury, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

In nearly all EU Member States, circulatory diseases were the most common main diagnosis for in-patients

For in-patients, the main diagnosis in 2018 across EU Member States was circulatory diseases, as shown in Table 3 and Figure 4. The rare exceptions to this were: Ireland where pregnancy and childbirth were the most common; Spain where diseases of the respiratory system were the most common; Cyprus where injury, poisoning and certain other consequences of external causes were the most common; and Luxembourg (2016 data) where diseases of the musculo-skeletal system and connective tissue were the most common. In Spain, Cyprus and Luxembourg, circulatory diseases were the second most common diagnosis, whereas in Ireland they were only the fourth most common. Across all of the Member States other diagnoses that were also common included neoplasms (benign or malignant cancers), diseases of the digestive system, , diseases of the respiratory system, injuries and other external causes, as well as pregnancy and childbirth.

Figure 4: Hospital discharges of in-patients, diseases of the circulatory system, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

The most common main diagnoses for day care patients were neoplasms 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, Ireland and Malta; diseases of the circulatory system in Denmark (2016 data), Germany (2017 data) and Sweden; injuries and other external causes in Poland and Finland; and mental and behavioural disorders in France.

Table 4: Hospital discharges of day care patients, by disease/injury, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch4)

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 may 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. A summary of the main deviations from the standard coverage is provided in the Data sources section below and highlights those national statistics where some of these issues can be found.

In 2018 (or the latest year for which data are available; see Figure 5), the average length of a hospital stay for in-patients ranged from 5.2 days in Bulgaria to 9.1 days in France, with the Netherlands below this range (4.5 days; note that the data for the Netherlands exclude all long-stay hospitals and exclude some or all psychiatric hospitals or mental health care institutions) and Czechia (9.6 days) and Hungary (9.8 days) above this range. Among the non-member countries for which data are available, Turkey (4.2 days; 2016 data) reported a particularly low average length of stay and Serbia (9.7 days; public sector hospitals only) a particularly high average.

Figure 5: Average length of stay for hospital in-patients, 2013 and 2018
(days)
Source: Eurostat (hlth_co_inpst)

Comparing the average length of stay in 2018 (or latest year) with the situation in 2013, about half of the EU Member States — 12 out of 25 (incomplete data for Greece and Portugal) — observed a reduction in the average length of time that patients spent in hospital. By far the largest decrease was in Finland, where the average fell from 10.6 days to 7.7 days between 2013 and 2018. By contrast, 11 Member States recorded an increase during this period and by far the largest was in France (up from 3.4 days to 9.1 days). Consequently, there were two Member States where there was no change — Czechia and Estonia.

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 2018 was generally longer in most of the EU Member States. The main exceptions to this pattern, as can be seen from Figure 6 were Malta (2017 data), Hungary and to a lesser extent Belgium and Austria, where female in-patients recorded longer hospital stays. By contrast, in Bulgaria, Germany (2017 data), Estonia, and Finland the average length of stays for female patients were the same as for male patients.

Figure 6: Average length of stay for hospital in-patients, by sex, 2018
(days)
Source: Eurostat (hlth_co_inpst)

The average length of in-patient stays tended to be shortest for children aged 1-9 years and highest for people aged 85 years 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 in 2018 was generally lower for young children aged 1-4 years or 5-9 years than it was for the youngest age group, in other words infants aged less than one year. Between the age groups 5-9 years and 10-14 years 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 years. Thereafter, the average length of in-patient stays increased through to the age group 55-59 years after which it stabilised briefly. From the age group 65-69 years 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 years and over. Nevertheless, in Germany (2017 data), the longest average stays were recorded among the age groups 55-59 years; for Latvia among people aged 45-49 years; for Cyprus and Sweden among infants aged less than one year; and for Denmark (2016 data) among infants aged less than one year and people aged 20-24 years. Hungary had the biggest difference in average length of stay between the age groups, with an average of 3.4 days for children aged 5-9 years rising up to an average of 30.2 days for people aged 95 years and over.

Table 5: Average length of stay for hospital in-patients, by age group, 2018
(days)
Source: Eurostat (hlth_co_inpst)

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. Note that in several Member States, 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 Spain and Czechia, where the average stay was 56.4 and 41.0 days respectively. 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, neoplasms, or injury, poisoning and certain other consequences of external causes.

Table 6: Average length of stay for hospital in-patients, by disease/injury, 2018
(days)
Source: Eurostat (hlth_co_inpst)

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 4.1 days (in Malta; 2017 data) and 6.7 days (in Italy) in hospital; patients diagnosed with diseases of the respiratory system, those diagnosed with diseases of the genitourinary system and those diagnosed with neoplasms also reported quite similar average lengths of stay across the Member States. For diseases of the circulatory system the average length of stay for in-patients was somewhat more diverse, and ranged from 4.3 days in Bulgaria to 12.6 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 the length of stay of patients in some or all psychiatric hospitals or mental health care institutions are excluded in several Member States.

Data sources

Key concepts

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. 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 2018 data (or the latest available year when 2018 data are not available) by EU Member States and non-member countries are listed below.

Types of institutions Main exception(s)
Belgium Excludes long-stay hospitals (covers only acute care hospitals) and psychiatric/mental health hospitals
Germany Excludes prevention and rehabilitation facilities with 100 or fewer beds
Ireland Excludes private hospitals, long-stay hospitals (covers only acute care hospitals) and psychiatric/mental health hospitals
Spain Day cases: excludes psychiatric and long-stay hospitals unless they form a hospital complex
France Excludes long-term care hospitals
Croatia Excludes prison hospitals
Italy and Poland Excludes military hospitals
Cyprus Excludes private hospitals and military hospital
Latvia Excludes providers of health care, which do not have a contract with the National Health Service, except for activities of inpatient care by such providers that are financed by the state
Lithuania and Romania Excludes hospitals that do not have a contract with the national health insurance fund
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 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); excludes obstetric and psychiatric hospitals in Scotland
Iceland Excludes specialised institutions such as rehabilitation centres, nursing homes or residential care facilities
Norway Excludes private hospitals
Switzerland Excludes prison and military hospitals
Serbia Excludes private hospitals, prison hospitals and military hospitals
Types of activity / treatment Main exception(s)
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)
Belgium (184 days), Italy (365 days), Lithuania (120 days for nursing hospitals), Slovakia (700 days) and the United Kingdom (Scotland; geriatric long-stay is excluded) Excludes long-term patients
France and Luxembourg Excludes non-residents
Lithuania Excludes nursing patients in nursing and general hospitals

The main diagnosis for discharges is based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10). 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.

Symbols

Note on tables:

  • a colon ‘:’ is used to show where data are not available;
  • a dash ‘–‘ is used to show where data are not applicable/relevant.

Context

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 out-patient 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.

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Health care (t_hlth_care)
Health care (hlth_care)
Health care activities (hlth_act)
Hospital discharges and length of stay for in-patient 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)