The changing pattern of in-patient care.

ABSTRACT

BACKGROUND: A nationally representative longitudinal study presented the opportunity to describe National Health Service (NHS) and private in-patient care used over seven years by a population of young adults in relation to known risk factors for admission and for future health. METHODS: Information on each hospital admission between ages 36 and 43 years, comprising length of admission and whether under NHS or private care, was collected from 1625 men and 1623 women, the population of the 1946 birth cohort study. Obstetric care was excluded from most analyses. RESULTS: From this population, 22 per cent of men and 39 per cent of women were admitted to hospital at least once during the seven-year period, for a total of 11,276 days, a mean of 3.5 days (SD 13.1) for each person in the study, and 11.6 (SD 21.9) days for those admitted. The proportion of admissions not under NHS care rose from 14 per cent of all admissions in 1982 to 23 per cent in 1989. Employers contributed to health insurance for 25 per cent of employed men and 7 per cent of employed women. Risk of admission was greater, and admissions were longer, in those least educated and from poorest circumstances; men with largest waist-hip ratios were admitted for longer than others. Private admissions were proportionately greater in nonmanual classes and among those from favourable social and educational backgrounds, that is, those known to be at least risk of serious and chronic illness. CONCLUSION: Heaviest users of in-patient care were those most likely to be at greatest health risk, who were least likely to have private health insurance. The rising mid-life uptake of private health insurance through employers (25 per cent of employed men by age 43 years) may foreshadow a future problem in a return to NHS care on retirement in this population, which represents the beginning of the future population bulge in the elderly.