Hospital discharge rates – the number of patients who leave a hospital after staying at least one night – are a core indicator of hospital activity. Improving timely discharge of patients can help the flow of patients through a hospital, freeing up hospital beds and health worker time. Both premature and delayed discharges worsen health outcomes and increase costs: premature discharges can lead to costly readmissions; delayed discharges use up limited hospital resources.
On average across OECD countries, there were 128 hospital discharges for acute care per 1 000 population in 2023 (Figure 5.22). Rates were highest in Germany and Austria (over 200 per 1 000 population), and lowest in Mexico, Costa Rica, Canada, the Netherlands, Chile and Italy (fewer than 100 per 1 000 population). Among accession and partner countries, rates were also high in Bulgaria and China, and relatively low in Argentina and Brazil. In most OECD countries, the number of hospital discharges fell between 2019 and 2023.
The average length of stay in hospital is an indicator of efficiency in health service delivery. All else being equal, a shorter stay reduces the cost per discharge, and shifts care from inpatient to less expensive settings. Longer stays can be a sign of poor care co‑ordination, resulting in some patients waiting unnecessarily in hospital until rehabilitation or long-term care can be arranged. At the same time, some patients may be discharged too early, when staying in hospital longer might have improved their health outcomes or reduced the chances of readmission.
In 2023, the average length of stay in hospital for acute care was 6.5 days across 36 OECD countries with comparable data (Figure 5.23). Türkiye and Mexico had the shortest hospital stays (4.7 days); Japan the longest (15.7 days). Since 2019, the average length of stay has decreased in most countries; the most significant declines occurred in Denmark and Belgium. However, average length of stay increased by over half a day on average in the United Kingdom and the United States.
Alongside these two core indicators of overall hospital activity, use of emergency care services is an important measure of frontline hospital services. Across 26 OECD countries with available data, there were an average 31 emergency department (ED) visits per 100 people annually in 2023 (Figure 5.24). Emergency care use was particularly high in Portugal and Spain, at over 65 ED visits per 100 people. While EDs provide a critical service, high use can be indicative of inappropriate and inefficient healthcare – notably if many patients attend EDs for non-urgent conditions that could be better managed in primary and community care settings. The Netherlands is an example of a country where GPs (through a system of co‑operatives) provide acute care in out-of-office hours. The numbers of ED visits have been relatively stable since 2019, although they have declined in 10 of 26 countries with available data. The largest decreases were seen in Italy and Chile, while ED visits increased markedly in Iceland and Slovenia.
More disaggregated data (not shown) reveals further insights. On average across 16 OECD countries, 64% of ED visits resulted in discharges to home, 20% in admissions for inpatient care, and 16% in other outcomes including deaths. Most people arrived at EDs by their own means (self-presentation), with or without a referral from a healthcare professional, and 14% used dedicated emergency transport, such as ambulances.
