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A Case Report From Leuven, West Berlin, Leiden, London, and San Francisco

Steven A. Schroeder, MD

JAMA. 1984;252(2):240-246.

Abstract
To assess how closely US university hospitals resemble those in other Western countries, I compared four major European university hospitals— Leuven, Belgium; Klinikum Steglitz, West Berlin; Leiden, the Netherlands; and St Thomas', London—with a US institution—University of California, San Francisco (UCSF). University of California had 1.6 to 2.4 more total employees, 1.1 to 1.7 more registered nurses, 2.1 to 8.5 more staff physicians, and 1.5 to 3.0 more house officers per adjusted occupied bed. University of California's costs per bed were 2.2 to 3.5 times higher, its inclusive per diem charges at least four times higher, and its malpractice premium at least 50 times greater. Medical patients at UCSF and West Berlin were more severely ill, as judged by organ system failure, need for organ system support, and levels of consciousness. Compared with UCSF, the European hospitals had more explicit rationing of care according to age and illness severity. Overall, European university hospitals are larger, less expensive, less technology intensive, staffed by fewer employees and physicians, occupied by less severely ill patients, and more apt to serve as regional referral centers. As US university hospitals move into a price-competitive era, they may come to resemble their European counterparts.

(JAMA 1984;252:240-246)

Author Affiliations
From the Division of General Internal Medicine and the Institute for Health Policy Studies, University of California, San Francisco, School of Medicine.

Footnotes
Reprint requests to Division of General Internal Medicine, 400 Parnassus Ave, A-405, University of California, San Francisco, CA 94143 (Dr Schroeder).

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