Hospital Use in

France and the

United States

This report presents national statistics on

hospital use from the U.S. National Hospital

Discharge Survey conducted by the

National Center for Health Statistics and the

national survey of hospitalization conducted

by CREDES, Centre de Recherche d’Etude

et de Documentation en Economic de la

Sante, previously the Medical Economics

Diwsion of CREDOC. The use statistics

compared between the two countries

Include rates and percent distributions of

discharges and days of care#md average

lengths of stay. These statistics are shown

by sex, age, diagnostic category, and other

hospital and patient characteristics. The

similarities and differences between the two

countries in population characteristics,

causes of death, health care systems, and

hospital systems are also described.

Comparative International Vital and

Health Statistics Reports

Series 5, No. 4

DHHS Publication No. (PHS) 89--1480

U.S. Department of Health and Human

Setvices

Public Health Service

Centers for Disease Control

National Center for Health Statistics

Hyattsville, Md.

January 1989
Copyright Information

The National Center for Health Statwtics has obtained perm!sslon from the

copyright holders to reproduce cerlaln quoted material in this report. Further

reproduction of this material IS prohibited without specific permtsslon of the

copyright holders. All other material contained m the report is in the public

domam and may be used and reprinted without spectal permission; cltatton as

to source, however, is appreciated.

Suggested Citation

National Center for Health Statistics, L, J. Kozak, E. McCarthy, A. Mizraht, et al

1989. Hospital use m France and the United States. Vifa/ and Hea/M SfaW/cs

Series 5, No. 4. DHHS Pub. No. (PHS) 89-1480. Washington: U.S.

Government Printing Office.

Lhrary of Congreaa Cataloging-in-Pubiiiation Date

Hospital use in France and the United States. (Vital & health statistics. Series

5, Comparative mternatlonal vital and health statistics reports ; no. 4) (DHHS

publication ; no. (PHS) 89-1480)

Supt. of Dots. no.: HE 20.6209:54

“This reporf presents national statistics on hospital use from the U.S.

National Hospital Discharge Survey conducted by the National Center for

Health Stat@ics and the national survey of hospttalizafion conducted by the

Medical Economics Division of the Centre de recherche pour l’6tude et

I’observation des conditions de vie (CREDOC)”.

Prepared by Lola Jean Kozak and others.

Bibliography: p.

1. Hospital utilization—United States—Statlstlcs. 2. Hospital utilizatlon—

France-Stat&ics. 1.Kozak, Lola Jean. II. National Center for Health Statistics

(U.S.). Ill. Centre de recherche pour I’etude et I’observation des conditions de

we. D6p. d~conomie medicale. IV. Series: Vital and health statistics. Series 5,

Comparative international wtal and health statistics reports ; no. 4. V. Series:

DHHS pubhcation : no. (PHS) 89-1480. [DNLM: 1. National Hospital Discharge

Survey (U.S.). 2. Hospitals—utilization-Franc~statist!cs 3. Hospltals—

utilization—United States—statistics. W2 A N148ve no. 4]

RA407.3.H63 1988 362.1 ‘1‘0973021 88+00248

ISBN &6408-042W
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P.H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis

and Epidemiology

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

George A. Schnack, Associate Director for Data Processing

and Services

Monroe G. Sirken, Ph. D., Associate Director for Research

and Methodology

Sandra S. Smith, Information O@cer

Dtision of Health Care Statistics

W. Edward Bacon, Ph. D., Director

Joan F. Van Nostrand, Deputy Director

Mary Moien, Chief, Hospital Care Statistics Branch

Manoochehr K, Nozary, Chief, Technical Services Branch

Cooperutim of the U.S. Bureau of the Census

Under the legislation establishing the National Health Survey, the Public Health

Service is authorized to use, insofar as possible, the services or facilities of other

Federal, State, or private agencies.

In accordance with specifications established by the National Center for Health

Statistics, the U.S. Bureau of the Census, under a contractual arrangement,

participated in planning the survey and collecting the da!a.
Introduction . . . . . . . . . . . . . . . . .

Highlights, . . . . . . . . . . . . . . . . .

Characteristics of the United States and France

Population . . . . . . . . . . . . . . . .

Health care system . . . . . . . . . . . .

Hospital system . . . . . . . . . . . . . .

Life expectancy . . . . . . . . . . . . . .

Causes of death . . . . . . . . . . . . . .

Hospital use . . . . . . . . . . . . . . . . .

Age and sex . . . . . . . . . . . . . . . .

Diagnosis, . . . . . . . . . . . . . . . .

Marital status, . . . . . . . . . . . . . .

Disposition, . . . . . . . . . . . . . . .

Hospital characteristics . . . . . . . . . .

Source of payment . . . . . . . . . . . .

Summary . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . .

List of detailed tables . . . . . . . . . . . .

Appendixes

1, Hospital discharge data systems . . . . .

II. Technical notes on methods . . . . . . .

III. Definitions of terms . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . ...! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

., ...! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.0 .,.! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

list of text figures

1.

2,

.,3

4.

5.

6.

7.

8.

9.

10.

11,

12.

130

Percent distributions of population by age: United States and France, 198I . . . . . . . . . . . . . . . . . . . . .

Percent female population in age groups: United States and France, 198I . . . . . . . . . . . . . . . . . . . . . .

Percent distributions of population 15 years of age and over by marital status: United States and France, 1981 . . . .

Rates of beds in hospitals and other health care facilities: United States and France, 198I . . . . . . . . . . . . . .

Rates of beds in hospital services: United States and France, 198I . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distributions of short-stay hospital beds by ownership: United States and France, 1981 . . . . . . . . . . .

Percent distributions of short-stay hospital beds by bed size of hospitak United States and France, 1981 . . . . . . .

Death rates byage:United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distributions of deaths by leading causes of death: United States and France, 1981 . . . . . . . . . . . . .

Death rates for infants under I year of age by leading causes of death: United States and France, 1981 . . . . . . .

Percent distributions of deaths by leading causes of death for children 1–14 years of age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Death rates for persons 15-44 years of age by leading causes of death: United States and France, 1981 . . . . , . .

Death rates for persons 45-64 years of age by sex and selected causes of death: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

3

5

5

8

9

12

12

20

20

24

32

34

36

39

43

45

47

67

72

78

6

7

8

9

10

11

11

13

14

14

15

16

17

,..

Ill
14. Death rates for persons 65 years of age and over by selected causes of death: United States and France, 1981 . . . .

15. Discharge rates for patients discharged from short-stay hospitals or services by age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. Discharge rates for males discharged from short-stay hospitals or services by age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. Discharge rates for females discharged from short-stay hospitals or services by age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18. Percent distributions of patients discharged from short-stay hospitals or services byage and sex: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. Rates of days of care for patients discharged from short-stay hospitals or services by age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20. Rates of days of care for males discharged from short-stay hospitals or services by age: United States and France.

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21. Rates of days of care for females discharged from short-stay hospitals or services by age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,.

22. Percent distributions of days of care for patients discharged from short-stay hospitals or services by age and sex:

UnitedStates andFrance,1981. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23. Average lengths of stay for patients discharged from short-stay hospitals or services by age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24. Average lengths of stay for males discharged from short-stay hospitals or services by age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25. Average lengths of stay for females discharged from shofl-stay hospitals or services by age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26. Discharge rates for patients discharged from short-stay hospitals or services for diseases of the circulatory system and

heartdisease: UnitedStates and France, ]981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27. Discharges from short-stay hospitals or services with acute appendicitis as a proportion of discharges with diseases of

thedigestivesystem: United States andFrance, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28. Discharge rates for patients discharged from short-stay hospitals or services by selected diagnostic categories: United

StatesandFrance, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .

29. Discharge rates for patients discharged from short-stay hospitals or services for diseases of the circulatory and

respiratory systems by sex: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30. Percents of days of care for selected diagnostic categories for patients discharged from short-stay hospitals or

services: UnitedStatesandFrance, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . .

31. Rates of days of care for patients discharged from short-stay hospitals or services for diseases of the circulatory

system and heart disease: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32. Average lengths of stay for patients discharged from short-stay hospitals or services by selected diagnostic categories:

UnitedStatesandFrance, 1981. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33. Percents of discharges for selected diagnostic categories for patients 15-44 years of age discharged from short-stay

hospitalsorservices: UnitedStates and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

34. Discharge rates for patients 45-64 years of age discharged from short-stay hospitals or services by selected

diagnostic categories: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35. Discharge rates for patients 65 years of age and over discharged from short-stay hospitals or services by selected

diagnostic categories: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36. Discharge rates for patients 15-44 years of age discharged from short-stay hospitals or services by marital status:

UnitedStatesandFrance, 1981.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

37. Discharge rates for patients 45–64 years of age discharged from short-stay hospirdk or services by marital status:

UnitedStatesandFrance, 1981. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38. Discharge rates for patients 65 years of age and over discharged from short-stay hospitals or services by marital

status: UnitedStates and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39. Percent distributions of patients discharged from short-stay hospitals or services by marital status: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40. Average lengths of stay for patients discharged from short-stay hospitals or services by marital status: United States

andFrance,1981 . . . . . . . . . . . . . . . , . . . . , . . . . . , . . . . . . . . . . . . . . . . . . . . . .

41. Percent of patients discharged home from short-stay hospitals or services by age: United States and France, 1981 . .

42. Average lengths of stay for patients discharged from short-stay hospitals or services by disposition: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43. Percent distributions of patients discharged from short-stay hospitals or services by bed size: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18

20

21

22

23

24

25

26

27

28

29

30

31

31

32

33

34

34

35

35

36

36

37

37

37

38

38

38

39

39

iv
44.

45.

46.

47,

48,

49.

Percent distributions of days of care for patients discharged from short-stay hospitals or services by bed size: United

States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Average lengths of stay for patients discharged from short-stay hosptials or services by bed size: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...40

Percent distributions of patients discharged from short-stay hospitals or services by ownership of hospitals: United

States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Percent distributions of days of care for patients discharged from short-stay hospitals or services by ownership of

hospitals: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Average lengths of stay for patients discharged from short-stay hospitals or services by ownership of hospitals:

United States and France, 1981..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Percent distributions ofpatients discharged from short-stay hospitals orservices bysource of payment: United States

and France, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..42

l-id of text tables

A. Selected characteristics: United States and France, 1981 . . . . . . . . . . . . . . . . . . . .

B. Health expenditures: United States and France, 1981 . . . . . . . . . . . . . . . . . . . . .

c. Percent distribution and rate of active physicians, by activity: United States, 1981, and France,

D. Life expectancy at selected ages by sex: United States and France, 198I . . . . . . . . . . . .

Symbols

..- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

. . . . . . . . . . 5

. . . . . . . . . . 8

980 . . . . . . . 8

. . . . . . . . . . 12

# Figure suppressed to comply with

confidentiality requirements
Hospital Use in France and

the United States

by Lola Jean Kozak and Eileen McCarthy, Division of Health

Care Statistics, National Center for Health Statistics, and

Andr6e Mizrahi,Arie Mizrahi,and Simone Sandier, Centre de

Recherche D’Etude et de Documentation en Economic de la

Sant&

Introduction

This report presents a comparison of short-stay hospital

usc in the United States and France. In the United States,

national estimates of the use of short-stay hospitals have been

available from the National Center for Health Statistics (NCHS)

since 1965. These estimates are based on the National Hospital

Discharge Survey (NHDS), a continuous, voluntary survey

that obtains a sample of inpatient records from a national

sample of short-stay hospitals in the United States. Data from

the survey include demographic characteristics of discharged

patients, characteristics of the hospitals where the patients

are treated, conditions diagnosed, and surgical and nonsurgical

procedures performed.

There is no similar ongoing national survey of hospital

use in France, Annual questionnaires on hospital facilities,

personnel, and use have been collected from the public hospitals in France since 1961 (Douxami et al., 1982) and from

private French hospitals since 1972 (Gottely and Puichaud,

1983), However, the questionnaires do not include information

about characteristics of patients or their diagnoses. In 1968,

a voluntary hospital morbidity study was established, but it

did not cover private hospitals, which account for more than

a third of French hospital discharges, and only about half

of the discharges from the public hospitals were reported

in the study (Gascon and Leroux, 1980).

From February 1981 to January 1982, a national survey

of hospitalization in both public and private French hospitals

was conducted by the Medical Economics Division of the

Centre de Recherche pour L’Etude et L’Observation Des Conditions de Vie (CREDOC), which is now the Centre de Recherche D’Etude et de Documentation en Economic de la

Sant6 (CREDES). Data collected in this survey were similar

to information available from the U.S. National Hospital Discharge Survey on patient characteristics and diagnoses. In

addition, it was possible to separate data for patients treated

in short-term hospital departments from the data for patients

in long-term departments.

Thus, the CREDES survey created a unique opportunity

to compare national patterns of short-term hospital use in

France and the United States. Such a comparison is expected

to make a contribution to the assessment of health problems

in the two countries, The comparison could also suggest new

approaches for providing health care in a more efficient manner, which is important because hospital care accounts for

a large proportion of total health costs in both France and

the United States,

This repoct is divided into two main sections. The first

section provides background information about characteristics

of France and the United States. Demographic characteristics

of the two countries, such as population distributions by age,

sex, and marital status, are compared. The health care systems

are briefly described, with attention to the supply of physicians

and the health insurance system in each country. The supply

and organization of U.S. and French hospital beds and differences in the distributions of beds by hospital ownership and

bed size are discussed. This discussion is followed by an

examination of the health status of the populations in the

two countries through a comparison of mortality statistics.

The life expectancies of males and females at different ages

are compared, and death rates are shown by age, sex, and

major causes of death.

The second main section is a comparison of hospital

use by characteristics of patients and hospitals. It begins with

a discussion of hospital use patterns by age and sex in the

two countries. The rates and distributions of hospitalizations

and hospital days and average lengths of stay are compared

by diagnostic category. Hospital use for diagnostic categories

is also examined for selected age groups.

The effect of marital status on hospital use patterns is

explored, and the disposition of patients at discharge is discussed. Distributions of discharges and days of care and average lengths of stay by hospital bed size and ownership

categories are compared. Finally, sources of payment for hospitalizations in each country are reviewed.

Data sources

The hospitals within the scope of the U.S. National Hospital Discharge Survey are short-stay non-Federal hospitals located in the 50 States and the District of Columbia. Short-stay

hospitals are defined as general and specialty hospitals in

which the average length of stay is less than 30 days. The

excluded Federal hospitals include inpatient facilities operated

by the Department of Defense, Veterans’ Administration, and

Indian Health Service. Hospital units of institutions such as

prisons are also excluded, as are hospitals with fewer than

six beds. Patients discharged from long-term or psychiatric

units of short-stay hospitals are excluded from the survey

if the units maintain a record system separate from the rest

of the hospital. Data on newborn infants are collected in

the survey but are not included in this report.

1
The NHDS has a two-stage sampling design. In the first

stage, hospitals are sampled in direct proportion to size. The

second stage consists of sampling discharges from the sampled

hospitals. Because the discharges are selected in inverse proportion to size, the overall probability of selecting a discharge

is approximately the same for each size hospital. Further

information about sample design and other aspects of the

survey can be found in appendix I. A detailed report on

the design of the survey is also available (NCHS, 1970).

In 1981, 428 hospitals participated in NHDS, and they provided approximately 227,000 abstracts of medical records.

The abstract is a one-page form that is completed using

information mainly from the face sheets of medical records.

The forms are completed by staff of the hospital’s medical

records department or field staff of the U.S. Bureau of the

Census. Medical information is coded centrally by staff of

the National Center for Health Statistics. In 1981, the ln?ernational Classification of Diseases, 9th Revision, Clinical Modijlcation (U.S. Public Health Service and Health Care Financing

Administration, 1980) was used for coding.

The French survey of hospitalization was carried out in

two stages. The first stage was a 1980 survey of hospital

institutions (Com-Ruelle et al., 1982). The second stage, the

survey of hospital departments and patients conducted Febmary

1981 to January 1982, was the data source for this report.

For the second stage, a sample of 301 hospital departments

was obtained from the sample of 296 hospitals that participated

in the first stage of the survey. A questionnaire was completed

on each patient discharged from the sampled departments

during a set observation period of 1 to 6 days. Data were

thus collected on a total of 2,229 discharges, of which 1,665

were discharged from short-term departments. Further information about the survey methodology is available in appendix I and in a separate report (Lecomte et al., 1980).

All French hospitals were within the scope of the French

survey except the military hospitals and hospitals in overseas

territories. Infirmaries within institutions such as prisons and

old age homes were not included. In addition, hospice sections

of general hospitals, which provide care similar to that in

U.S. nursing homes, were excluded. Short-term departments,

which are included in this report, are medicine and medical

specialties, surgery and surgical specialties, and obstetrics

and gynecology. The medium and long-term departments,

which are excluded, are the psychiatric, chronic care, convalescence, and rehabilitation departments. Data on French newborn

infants are not included in this report.

The patient questionnaire was approximately 40 pages

long, much more detailed than the U.S. abstract form. The

questionnaire was filled out by hospital staff. The medical

information, and sometimes the whole questionnaire, was completed by a department physician. The data were coded centrally. A team of physicians coded the medical data using the

Manual of the International Statistical Class@ation of Diseases, Injuries, and Causes of Death, 9th Revision (World

Health Organization, 1977).

In the French survey, data were collected only on patients

who stayed in the hospital overnight. To improve the comparability of thedata, patients who were admitted and discharged

on the same day were excluded from the U.S. statistics.

Thus, the statistics presented here are slightly different than

those in earlier NHDS reports on U.S. hospital use in 1981

(NCHS, 1983a).

Familiarity with the methods and definitions used in the

U.S. and French surveys is important for interpreting the

data and making comparisons between the countries. Appendix II provides technical notes about the methods used to

make national estimates, sampling and measurement error,

guidelines for presentation of estimates, and the like. Definitions of terms used in the report are presented in appendix 111.
Highlights

Age and sex

●

●

●

●

●

●

●

●

●

●

The discharge rate was 23 percent higher in the United

States than inFrance.

The U.S. discharge rate was60 percent higher than the

French rate forpatients45–54 years of age, 54 percent

higher for the 65–74 year group, 71 percent higher for

patients 75–84 years of age, and more than twice the

French rate for patients 85 years of age andover.

U.S. females hadadischarge rate 32percent higher than

French females.

The U.S. discharge rate was 82 percent higher than the

French rate for male patients 75–84 years of age.

U.S. females 45–54 years of age had a discharge rate

twice that of French females in the same age group.

Discharge rates were also 69 percent higher for females

65–74 years and 65 percent higher for females 75–84

years in the United States.

The rate of days of care was higher in France than in

the United States.

The rate of days of care for U.S. males was 25 percent

lower than the rate for French males.

The average length of stay was 11.2 days in France,

50 percent longer than the average stay of 7.4 days in

the United States.

The French average length of stay was 85 percent longer

for children 1–14 years of age, 40 percent longer for

the three age groups within the 15-44 year group, 50

percent longer for patients 55-64 years and 75–84 years,

and 75 percent longer for patients 65–74 years and 85

years and over.

Both male and female patients were hospitalized significantly longer inFrance than in the United States.

Diagnosis

●

●

●

The U.S. discharge rate was 89 percent higher for the

entire circulatory dkease category and 4.5 times the

French rate for heart disease.

The discharge rate for diseases of the circulatory system

was 8I percent higher for males and 96 percent higher

for females in the United States than inFrance.

The U.S. rate of days of care for heart diseases was

more than twice the French rate.

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

●

The French average length of stay for diseases of the

circulatory system was 64 percent longer than the U.S.

average stay.

The U.S. discharge rates for diseases of the circulatory

system for patients 45-64 years of age and 65 years

of age and over were more than twice the French rates.

About one in every five females discharged from a hospital

in both the United States and France had a diagnosis

in the category of complications of pregnancy, childbirth,

and the puerperium.

The average lengths of stay were significantly longer

in France than in the United States for complications

of pregnancy, childbirth, and the pue~erium and its subcategory of uncomplicated deliveries.

The U.S. discharge rate for diseases of the respirato~

system was more than twice the French rate.

The discharge rate for diseases of the respiratory system

was 79 percent higher for males in the United States

than for males in France. The rate for U.S. females was

2.8 times the rate for French females.

The U.S. discharge rates for diseases of the digestive

system for patients 45-64 years of age and 65 years

of age and over were more than twice the French rates.

The French discharge rate for acute appendicitis was nearly

four times the U.S. rate.

The U.S. discharge rate for diseases of the genitourinary

system was 76 percent higher than the French rate.

U.S. females had a discharge rate 90 percent higher for

genitourinary diseases than French females had.

The French discharge rate for symptoms, signs, and illdefined conditions was 2.4 times the U.S. discharge rate.

The French rate of days of care for symptoms, signs,

and ill-defined conditions was 5.5 times the U.S. rate.

The average length of stay for symptoms, signs, and

ill-defined condhions was significantly longer in France

than in the United States.

U.S. males had a rate of days of care for mental disorders

that was more than twice the rate for French males.

The U.S. rate of days of care for mental disorders for

patients 15-44 years of age was 2.7 times the French

rate.

The discharge rate for patients 65 years of age and over

was 4 I percent higher in the United States than in France

for neoplasms and 83 percent higher for its subcategory,

malignant neoplasms.

3
Marital status

●

●

●

●

●

●

The patterns of hospital use by marital status were generally similar in the United States and France.

In the United States, rates of discharges and days of

care were higher for married persons 15-44 years of

age than for single persons in that age group.

The rates of discharges and days of care were higher

in the United States for single than for married persons

45-64 years of age and 65 years of age and over.

The proportions of discharges and days of care in the

United States for divorced or separated patients were three

times the proportions inFrance.

Average lengths of stay were significantly longer for

French than for U.S. patients for most marital status

categories.

Married U.S. patients generally had shorter average

lengths of stay than patients in the same age group who

did not have spouses.

Disposition

●

●

●

●

●

●

In both France and the United States, more than 80 percent

of patients were discharged to their place of residence.

The proportion of patients discharged dead was similar

in the two countries.

French patients were twice as likely as U.S. patients

to be reported as transfers.

The percent of patients transferred was significantly higher

in France for patients 15-44 years of age and 45-64

years of age. but not for patients 65 years of age and

over.

In both countries, the percent of patients discharged to

their place of residence decreased with age and the percent

transferred or discharged dead increased.

Average lengths of stay were longer in both countries

for patients transferred and discharged dead than for patients discharged to their usual place of residence.

Hospital characteristics

● Hospitals with 1,400 beds or more accounted for almost

a third of discharges and a fourth of days of care in

●

●

●

●

●

●

France, but for less than 1 percent of each in the United

States.

Hospitals with 120-799 beds accounted for approximately

three-fourths of discharges and days of care in the United

States, but for only 36.2 percent of discharges and 41.7

percent of days of care inFrance.

French average lengths of stay were 4.1 to 6.4 days

longer for hospitals with 50-799 beds, but were similar

to U.S. average stays for hospitals with 800 beds or

more.

The majority of discharges and days of care were in

private nonprofit hospitals in the United States and in

public hospitals inFrance.

The proportions of discharges and days of care in private

for-profit hospitals in France were three times the proportions in the United States.

In France, less than 20 percent of children under 15

years of age and of the elderly 65 years of age and

over were hospitalized in private for-profit hospitals. More

than 30 percent of patients 1544 years and 45-64 years

of age were discharged from private for-profit hospitals.

French patients had longer average lengths of stay than

U.S. pa~ents in each hospital-ownership category. -

Source of payment

●

●

●

●

In the United States, private insurance was the principal

expected source of payment for more than half of

hospitalizations.

The primary source of payment for almost all French

hospitalizations was the sick fund, the national health

insurance program of France, All hospital costs were

covered by the sick funds for 63 percent of French hospital

patients.

Nearly half of hospitalized U.S. patients whose principal

expected source of payment was Medicare also had private

insurance and another 11 percent were also covered by

Medicaid.

About a third of French hospital patients covered by the

sick fund were charged for a proportion of their hospital

costs, but more than half had private insurance to cover

these charges.
Characteristics of the

United States and France

The number of people in the United States is more than

four times the number in France. In 1981, the U.S. population

was estimated at 227.7 million, the French population at 54

million (table A and table 1). The area of the United States

is more than 17 times the area of France, but in 1981 France

had 98,3 persons per square kilometer, more than four times

the population density of the United States of 24.3 persons

per square kilometer. The majority of the population in both

countries lived in urban areas, but the United States, unlike

France, has large areas that are very sparsely populated. This

difference in population distribution is probably one reason

that the United States has a larger proportion of small hospitals.

Comparison of the gross domestic product per capita in

the two countries suggests that the United States enjoys a

higher standard of living than France. In equivalent purchasing

power, the gross domestic product per capita was 29 percent

higher in the United States.

Another economic difference between the countries is

that the population active in the labor force was more likely

to be engaged in a service occupation in the United States.

The service sector accounted for 66.4 percent of the civilian

labor force in the United States, 56.2 percent in France.

The proportion of the labor force was higher in France for

both agriculture, forestty, and fisheries (8.6 percent compared

Table A, Selected characteristikx United Statea and France, 1981

Characteristic United States France

Population distribution Number

Resident population. . . . . . . . . . . . . . . . 227,659,000 53,965,61 ()

Area In square kilometers . . . . . . . . . . . . 9,363,123 549,192

Persons per square kilometer . . . . . . . . . . 24.3 96.3

Gross domestic product per capita Amount

Innatlonal currency . . . . . . . . . . . . . . . . $12,769 57,557 FF

Purchasing power parities’ . . . . . . . . . . . . $12,759 $9,655

Percent distribution of civilian labor force Parcant distribution

Total, . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Agriculture, forestry, fisheries. . . . . . . . . . . 3.5 6.6

Industry . . . . . . . . . . . . . . . . . . . . . . 30.1 35.2

Services . . . . . . . . . . . . . . . . . . . . . . 66.4 56.2

‘One dollar had Ihe same purchasing pwer ss 5.84 French Francain 19al.

SOURCES U.S. Sureau of the Census. 1982. Preliminaryestimates of the peculation of the

Unllad Statas by age, sex, and race 1970-19LM. Current Population Reports. Series P-25,

No. 917. Washington: US. Government Printing Office; United Nations. 19a3. Dernegr@ric

Yeadwek, W81. New Yorlc Instllut Natiinal de la Statistique et des Etudes Ecmnomiques.

19S3, Anrruaire SMisfiqtre de /a France, 1982. Paris; Organization for Economic Cooperation

and Development, 19S3. Nefiorra/ ,4ccotmfs, Main ,4ggregafes. W 1. 7952-1987. Paris.

with 3.5 percent in the United States) and industry (35.2

percent compared with 30.1 percent in the United States).

Population

People 65 years of age and over, who use considerable

amounts of hospital care, make up a larger proportion of

the population in France than in the United States. In 1981,

13.9 percent of the French population was 65 years of age

and over compared with 11.5 percent of the U.S. population

(table 2). As can be seen in figure 1, more of the French

than of the U.S. population was 65–74 years of age (7.6

percent versus 7.0 percent), 75–84 years of age (5.0 percent

versus 3.5 percent), and 85 years of age and over (1.3 percent

versus 1.0 percent). A smaller proportion of males than of

females were 65 years of age and over in each country,

but a greater proportion of both sexes were elderly in France.

Males 65 years of age and over accounted for 1I percent

of the male population in France, 9.6 percent in the United

States. Females in this age group made up 16.7 percent of

the female population in France, 13.3 percent in the United

States.

More than half of the population in both countries was

under 35 years of age. The proportion of the population in

this age group was greater in the United States, 57.4 percent,

than in France, 53 percent. More of the U.S. than of the

French population was under 1 year of age (1.6 percent versus

1.5 percent), l–l 4 years (20.9 percent versus 19.8 percent),

15–24 years (18. 1 percent versus 15.8 percent) and 25–34

years (16.8 percent versus 15.9 percent). In contrast to the

elderly population, a larger percent of males than of females

were under 35 years of age in both countries, and a larger

percent of both sexes were under 35 years of age in the

United States. Males under 35 years of age accounted for

59.6 percent of the male population in the United States,

55.2 percent in France. Females in this age group made up

55.5 percent of the female population in the United States

compared with 50.9 percent in France.

The proportion of the population 35–64 years of age

was higher in France, 33.2 percent, than inthe United States,

31 percent. About the same proportions were 35-44 years

of age (11.5 percent in the United States, 11.6 percent in

France) and 55-64 years of age (9.6 percent in the United

States, 9.8 percent in France). However, the group 45–54

years of age made up 11.8 percent of the French population

compared with 9.9 percent of the U.S. population. Thedistri5
Under

1 year

1-14

years

15-24

years

25-34

years

35-44

years

45-54

years

55-64

years

65-74

years

75-64

years

65 years

and over

o 5 10 15 20 25

Percent

❑ United States

❑ France

F@rel. Percent distributions ofpopulsMnby~ United States and France, 1981

bution.of the male and female populations followed the same

pattern. A higher percent of the French than of the U.S.

population of each sex was 35-64 years of age, the difference

mainly attributable to a greater proportion of French males

and females 45–54 years of age.

There were more females than males in both France and

the United States. Females made up 51.7 percent of the U.S.

population and 51.0 percent of the French population in 1981

(table 3). In the United States, females accounted for more

than half of the population in each age group except the

two youngest, under 1 year of age and 1–14 years (figure 2). In France, though, males outnumbered females in

each of the age groups under 45 years of age. The presence

of male immigrant workers in France may help to explain

this difference. The predominance of females increased in

the three age groups 65 years of age and over. The population

85 years of age and over was 70.1 percent female in the

United States and 75.6 percent female inFrance.

The distributions of the population 15 years of age and

over by marital status were generally similar in the two coun6
80

70

50,

,

0

48.8 48.(

Under

1 year

----- ——--- .

48.9 48.8

K

K

1–14

years

1E-24

years

25-34

years

35-44

years

Age

45-54

years

53.2

[

52.,

K

55-64

years

❑ UnitedStates

❑ Ram.

75.6

70.1 r

S3.7

63.0f85 years

and over

65-74

years

75-64

years

Figure 2. Percent female population in age group= United States and France, 1981

tries (figure 3). The main difference was that 6.2 percent

of the U.S, population was divorced compared with only

3.3 percent of the French population, Another 2.4 percent

of the U.S. population was separated, a category not reported

for the French population. The French population was somewhat more likely to be married (60.6 percent versus 58.2

percent of the U.S. population), single (27.0 percent versus

25.8 percent), or widowed (9.1 percent versus 7.3 percent).

There was some variation in these patterns for different

age groups. For example, a larger percent of the French population 1544 years of age and 45–64 years of age were married,

but the proportion of people 65 years of age and over that

were married was higher in the United States (table 4). Although more of the French population 65 years of age and

over was widowed, the percent widowed was higher in the

United States for the group 45-64 years of age, and it was

the same in the two countries for the group 15-44 years

of age. Single people made up a larger proportion of the

7
Separated

Divorced 2.4%

6.2’%

Widowed

7.3%

United States France

Fwure 3. Percent distrixrtkms of population 15 yeara of age and over by marital atatu.% United States and France, 1981

French population in each of the three age groups, and the

divorced population was larger for each age group in the

United States.

Healthcare system

Personal health expenditures amounted to $1,090 per person in the United States in 1981, which was 42 percent higher

than personal health expenditures in France of $768 per person

in equivalent dollars (table B). Personal health expenditures

also made up a larger proportion of the gross national product

in the United States, 8.7 percent as compared with 7.8 percent

inFrance.

Because of variations in definitions, the statistics on costs

of institutional care are not completely comparable in the

TWe B. Health expenditures United States and France, 1981

Expenditure United States France

Personal health expenditures Amount

Per capita

National currency . . . . . . . . . . . . . . . . . . $1,090 4,485FF

Purchasing power parities’ . . . . . . . . . . . . . $1,090 $ 768

Percent

Percent of gross national product . . . . . . . . . . 8.7 7.8

Institutional care expenditures Amount

Per capita:

National currency . . . . . . . . . . . . . . . . . . $ 807 2,253 FF

Purchasing power paritiest . . . . . . . . . . . . . $ 607 $ 386

Percent

Percent of personal health expenditure . . . . . . . 55.7 50.2

~Ons delkr had the same purchasing power as 5.S4 French Frarws in 1981.

SOURCES Robert M. Gibson and Daniel R. Waldo. 1982. National health expenditures,

19S1. Health Cam Financing Revkw. 4(1 )5-35 Centre de Rsafwche fSEtude et de

Documentation en J%onomie de h Sant& Software Programme C.M.F.-C.R.E.D., Pariq

Organization for EconomicCooperationand Devebpmant.1983. NstrbnalAccovrrfs,Main

A9wf7ates. Vol. 1. 19S2-1981. Paria.

two countries. However, institutional care—that is, care in

hospitals and nursing home type facilities—appears to account

for about half of personal health expenditures in both countries.

The U.S. population spent $607 per person on institutional

care, which was 57 percent higher than the $386 per person

in equivalent dollars spent in France. The U.S. institutional

care expenditures can be broken down into $505 per person

for hospital care and $102 per person for nursing home care.

The supply of active physicians was larger in France

than in the United States. There were 20.1 physicians per

10,000 population in France compared with 18.6 physicians

per 10,000 population in the United States (table C). The

distributions of physicians by practice settings were very similar. Approximately two-thirds of the active physicians in each

country were primarily in private office-based practices. Many

of these physicians were also employed part time as hospital

staff or in other activities,

In the United States, 70.7 percent of the physicians who

were not in office-based practice (23.3 percent of all U.S.

physicians) were in hospital-based practices. The majority

of these physicians were residents in specialty training. Besides

serving in hospital and office-based practices, U.S. physicians

Table C. Percent distributionand rate of ectiie physician% by -

United Stetea, 1981, and France, 1960

United United

Activity States France States France

Rate per 10,000

Percent distribution population

All active physician . . . . . . . 100.0 100.0 18.6 20.1

Office-baaed practice . . . . . . . 67.1 67.8 12.5 13.6

General practice . . . . . . . . 11.6 41.8 2.2 0.4

Specialized practice . . . . . . 55.5 26.0 10.3 5.2

Other active physicians . . . . . . 32.9 32.2 6.1 6.5

SOURCES Physician Charscterisfiss and Dktnbutian in the U.S., 1982 Edition. Department

of Phys.Wan Data Services. Oivisfon of Survey and Date Reecamss. Chicago Amerirmn

Mediil Assxiation (Copyrfght 1983 Used w’kh the permission of the American Medical

Asa@atiin] Ministere des Affakes socia!es et de la Solidarif6 Natbnale. 1964. Annu8im

&s StatistquesSanitaireset Soeiafaa19S8-19SS.Paris.

8
were active mainly in research, administration, and medical

teaching. Data were not available on the activities of the

French physicians not in office-based practice, but most of

them were also likely to be full-time hospital staff.

Physician specialization was much more common in the

United States than in France. Specialists made up 83 percent

of office-based physicians in the United States compared with

only 38 percent in France. The U.S. rate of office-based

specialists was almost twice the French rate. Conversely, the

French rate of office-based general practitioners, 8.4 per

10,000 population, was almost four times the rate in the

United States of 2.2 per 10,000 population. It should be

noted, however, that specialization was defined differently

in the two countries. The U.S. data were taken from reports

by physicians about whether they were in general or specialized

practice. In France, “specialist” refers to a physician trained

and certified in a specialty, All French physicians who were

not certified were counted as general practitioners.

In both France and the United States, patients are generally

free to choose the physician they wish to visit for care, and

they can visit either a general practitioner or a specialist.

Physicians in office-based practice in both countries are usually

reimbursed on a fee-for-service basis, but the fees are more

strictly regulated in France. Staff physicians in hospitals are

generally salaried in both countries.

There is a greater degree of separation between ambulatory

and inpatient care in France than in the United States. U.S.

physicians in office-based practice usually not only provide

ambulatory care but can admit their patients to hospitals and

take responsibility for inpatient treatment. Office-based practice in France is concentrated on the provision of ambulatory

care. Hospital staff physicians treat French patients admitted

to the public hospitals. Private French hospitals do allow

office-based physicians to admit and treat patients, but these

facilities account for less than a third of French hospital beds.

Separation between ambulatory and inpatient care may

result in low rates of hospitalization in France because the

ambulatory care physicians are less likely to refer their patients

to hospitals. Longer hospitalizations may also result because

the patients who are admitted are more seriously ill and because

the hospital physicians want to supervise patients until they

are fully recovered.

Virtually ail of the French population (99.2 percent) is

protected by health insurance. Most are covered by a compulsory insurance system, but coverage for some is voluntary.

These insurance systems generally do not cover the total costs

of health care services, leading many people in France to

purchase supplementary benefits from mutual societies, which

are private insurance organizations. Insurance usually provides

the most complete coverage of the costs of hospital care

and covers less of the costs of drugs and ambulatory care.

In 1981, the national government financed about 2.3 percent

of all health care costs, the mutual societies 3.5 percent,

and the other insurance programs 73.3 percent. The remaining

20.9 percent of health care costs were paid directly by patients.

In the United States, there are two main public programs,

Medicare, a national program that provides health insurance

protection primarily for people 65 years of age and over,

and Medicaid, a joint Federal-State welfare program that provides medical benefits for persons, including the aged, who

meet each State’s definition of “low income.” The rest of

the population resorts mainly to the purchase of private health

insurance. However, 12 percent of the U.S. population had

no insurance in 1981 and thus was unprotected against the

financial risks of illness. As is the case in France, hospital

care is more likely than other health services to be covered

by insurance. In 1981, 39.8 percent of the costs of health

care were paid by Federal, State, or local government, 31.1

percent by private insurance plans, and 1.2 percent by private

charities and industry. The remaining 27.9 percent of costs

were paid directly by patients (Levit et al., 1985).

Hospitsl system

The supply of beds in hospitals and other health care

facilities was considerably larger in France than in the United

States. The French rate of beds, at 177 per 10,000 population,

was 42 percent higher than the U.S. rate of 124.6 per 10,000

population (table 5). These totals include both hospitals and

long-term care facilities, which are nursing homes in the United

States and, in France, hospital departments and homes for

the elderly and convalescent homes. The rate of beds per

10,000 population in the long-term care facilities was very

similar in the two countries (figure 4). However, since the

elderly population was larger in France, the supply of beds

per 10,000 population 65 years of age and over was about

20 percent larger in the United States. Some of the types

of patients treated in nursing homes in the United States

are thought to be cared for in long-term hospital services

inFrance (NCHS, 1983b).

The rate of hospital beds per 10,000 population was 111.4

in France, 88 percent higher than the U.S. rate of 59.4 per

10,000 population. Differences in rates were reported across

the various hospital services (figure 5). The French rate was

38 percent higher for medical and surgical services and was

more than twice the U.S. rate for obstetrics and gynecology

and psychiatric services. Tuberculosis and other long-term

care services accounted for only 9.6 percent of U.S. hospital

■ Lo.g-termmrefacilities

❑ .o.spitalbad.s

65.2 59.4

I

United States

65.5 111.4

France

I I I I I 1 I t f

75 50 25 0 25 50 75 100 125

Rate per 10,000 population

Fgure 4. Rates of beds in hospitals and other health ears kilif.k

United Statea and Franoe, 1981

9
Medical and

surgical

55.2

Obstetrics and

gynecology

5.9

❑ United States

❑ France

al

.9

$

In Psychiatric

3

---

n

(n 25.2

2

b

0.2

Tuberculosis

2.0

Other long-term

23.1

I 1 I I I I [ I I I

o 6 12 18 24 30 36 42 48 54 60

Beds per 10,000 population

Fiiure 5. Rates of beds in hospital service= United States and France, 1981

beds, a rate of 5.7 per 10,000 population. These services

made up 22.5 percent of French hospital beds, or 25.1 beds

per 10,000 population.

The supply of beds in private health care facilities was

larger in the United States (96.6 beds per 10,000 population)

than in France (58 beds per 10,000 population). Rates of

private hospital beds did not differ greatly in the two countries,

but the U.S. rate of private nursing home beds was 60.4

per 10,000 population, compared with 24.5 beds per 10,000

population in private long-term care facilities in France.

Beds in public health care facilities were much more

plentiful in France. The French rate of public hospital beds

“was77.9 per 10,000 population, more than three times the

U.S. rate of 23.2 per 10,000 population. For long-term care

facilities the difference was even more pronounced; there were

41.1 public beds per 10,000 population in France and only

4.8 per 10,000 population in the United States.

Among hospital services, beds in psychiatric services and

other long-term services were predominantly public beds in

both countries. Tuberculosis beds were also mainly public

beds in the United States, but there were more private than

public tuberculosis beds in France. In all the services except

the tuberculosis service, more French hospital beds were public

than were private. In the United States, though, beds in both

.. . . .

medical and surgical services and obstetrics and gynecology

services were mainly in private rather than public hospitals.

Although the rates of private hospital beds did not differ

greatly in the two countries, most private beds in the United

States were in nonprofit hospitals whereas more private beds

in France were in for-profit than in nonprofit hospitals (figure 6). More than half of all U.S. hospital beds and 63.9

percent of short-stay hospital beds were in nonprofit hospitals,

compared with 12.5 percent of all beds and 11.2 percent

of short-stay beds inFrance (table 6). The U.S. rate of nonprofit

beds per 10,000 population was more than twice the French

rate for all hospitals, and more than four times the French

rate for short-stay beds.

In France, 17.5 percent of all hospital beds and almost

a fourth of short-stay beds were in for-profit hospitals, compared with 7.5 percent of all beds and 8.5 percent of short-stay

hospital beds in the United States. For the for-profit hospitals,

the French rate of beds per 10,000 population was more

than four times the U.S. rate for all hospitals and three and

a half times the U.S. rate for short-term hospital beds.

As was discussed previously, public hospital beds were

more abundant in France. They accounted for almost 70 percent

of all French hospital beds and for 64.8 percent of short-stay

beds. U.S. public hospitals made up 39.1 percent of all hospital

10
United States France

I

Figurv 6. Peroent distributionsof short-stsy hospitsl beds by ownership United Ststes and France, 1981

1“10

1,400 beds or more

4.3%

Less than 50 beds

Uniled States

8.7°h

Less than 50 beds

France

Fwure 7. Percent distributions of short-stay hospital beds by bed size of hospital: United States and France, 1981

beds and 27.6 percent of short-stay hospital beds. The rate French hospital beds were more likely than were U.S.

of short-stay public beds in France was almost three times beds to be in hospitals with 800-1,399 beds. In addition,

the rate in the United States.

The distribution of hospital beds by bed size categories

differs considerably in the two countries (figure 7). Especially

striking is the difference in the proportion of beds in the

largest hospitals. In France, hospitals with 1,400 beds or

more contain 22 percent of all hospital beds and 23.9 percent

of short-stay beds. Hospitals with 1,400 beds or more in

the United States make up only 4.6 percent of all hospital

beds and 1.0 percent of short-stay hospital beds (table 7).

larger proportions of French beds fell into the two smallest

bed size categories, less than 50 beds and 50-119 beds. These

differences held for all hospital beds and for short-stay beds.

In the United States, two-thirds of all hospital beds and

72.2 percent of short-stay hospital beds were in hospitals

with 120-799 beds. Only 37.1 percent of all beds and 38.4

percent of short-stay beds were in hospitals with 120-799

beds in France.

11
Life expectancy

Data on life expectancy suggest that the health status

of the populations in the United States and France are similar,

Males born in 1981 in either country could expect to live

to 70.4 years of age, and females born in 1981 could expect

to live to 77.9 years of age in the United States, 78.5 years

of age inFrance (table D).

The life expectancy for people at other ages was also

generally similar in the two countries. At 15 and 45 years

of age, males had a slightly longer life expectancy in the

United States; females could expect to live slightly longer

in France. Both males and females 65 years and 80 years

of age had a longer life expectancy in the United States.

The difference was only 0.4 of a year for persons 65 years

of age, but at 80 years of age, U.S. males could expect

to outlive their French counterparts by 0.8 year, and U.S.

females could expect to live 1.3 years longer than French

females.

The differences in life expectancy result from variations

in death rates by age and sex (table 8). The crude death

rate was higher in France, but that was because of a higher

proportion of elderly and higher death rates for persons 75

years of age and over in France. For age groups under 75

years of age, the death rates were higher in the United States

(figure 8).

The largest difference between the countries was in death

rates for infants under 1 year of age. The U.S. death rate

was 23 percent higher for the whole age group under 1 year

of age and 31 percent higher for females in their first year

of life. The smallest difference in death rates was for children

1–14 years of age. In fact, French girls 1–14 years of age

had a slightly higher death rate than U.S. girls.

The differences between U:S. and French death rates

also vaned by sex for other age groups. Greater differences

were found in the death rates of males than of females for

the age groups 15–24 and 25–34 years of age. For example,

U.S. males 25–34 years of age had a death rate 20 percent

higher than French males, but the death rate of U.S. females

in this age group was only 11 percent higher than the rate

for French females. The reverse was true for the age groups

35-44, 45–54, 55-64, and 65-74 years of age, where the

differences in death rates of females were greater than the

differences in the rates of males. The sex differences for

Tsbk D. Life expectancy at selected ages by sex United States and

Frence, 1981

Males Females

United United

Age States Francs States France

Life expectancy in years

At birth . . . . . . . . . . . . . . 70.4 70.4 77.9 78.5

At15years . . . . . . . . . . . . 56.8 56.6 64.1 64.4

At45years . . . . . . . . . . . . 29.4 29.0 35.4 35.7

At65 years . . . . . . . . . . . . 14.4 t 4.0 18.6 18.2

At80yeare . . . . . . . . . . . . 8.9 6.1 8.9 7.6

SOURCES Natiinal Center for Heallh Statistics. 1984. Advance report of final mortality

slatietii, 1961. Month/y VitalStatisticsRs@. Vol. 33, No. 3, Supp. DHHSPub. No. (PHS)

64-1120. PubIii Heafth 8eIvke. Hyatfaville,Md.; United Natbns. 1986. Demographic

Yearbook, 19S4. New ‘fork.

the age groups 45–54 and 55-64 years of age were particularly

noteworthy. Males 45–54 years of age had a 4-percent higher

death rate in France, but females in that age group had a

32-percent higher death rate in the United States. For the

age group 55-64 years, the death rate was 10 percent higher

in the United States for males but 45 percent higher for females.

Causes of death

Death rates for leading causes of death in France and

the United States are shown in table 9. Diseases of the circulatory system and neoplasms were the most important causes

of death in both countries. The death rate for circulatory

diseases was higher, and circulatory diseases accounted for

a larger proportion of deaths (figure 9) in the United States.

The death rate and the proportion of deaths for neoplasms

were higher in France. To some extent, these variations may

reflect differences in the selection of underlying cause of

death. Studies have shown that when given the same set

of death certificates, U.S. coders were more likely than coders

in other countries to choose a circulatory disease as the underlying cause of death; French coders were more likely to choose

cancer (Percy and Dolman, 1978).

Among the circulatory diseases, the U.S. death rate for

ischemic heart dkease was two and a half times the rate

inFrance, and the rate for myocardial infarction was 75 percent

higher in the United States. French rates were higher for

cerebrovascular dkease and for heart failure and ill-defined

heart disease.

In the neoplasm category, the United States had a 42-

percent higher death rate for malignant neoplasms of the

trachea, bronchus, and lung. It is interesting to note that

U.S. death rates were also higher for chronic obstructive

pulmona~ disease and pneumonia, although the French death

rate was higher for aIl respiratory dkeases.

The French death rate was higher for malignant neoplasms

of the intestine, rectum, and anus. In addition, the death

rate in France was more than twice the rate in the United

States for diseases of the digestive system and the subcategory

of alcoholic liver disease and other cirrhosis of the liver.

Large differences were found in the death rates and proportions of deaths for the category of symptoms, signs, and

ill-defined conditions. The French death rate was over five

times the U.S. rates for that category, which accounted for

6.5 percent of French deaths compared with only 1.5 percent

of U.S. deaths. Within the category, deaths about which virtually no information about cause was available were assigned

to the subcatego~ of unknown and unspecified cause. This

subcategory was reported almost three times more frequently

inFrance than in the United States.

Under 1 year

The leading causes of death for persons of all ages primarily reflect the causes for older people, whose death rates

are much higher than the rates for the younger population.

Therefore, leading causes were also compared for specific

age groups. Table 10, illustrated by figure 10, presents leading

causes of death for infants under 1 year of age in France

and the United States.

12
loo,ooo__

k

7 ----

6 ----

5----

4 ----

3----

2 ----

10,000 ---

9 ---

8 ---

7 ---

6 ---

5 ---

4 ---

3 ---

i! 2---

g

3 -.

2 -.

100,

9

6

7

6

5

4

3

2

1

, France

\

1

\

I

\

\

o

I I

20

1 1 f

40 60 80 100

Age in yeara

Figure 8. Death rates by age United States and France, 1981

13
3.7% i .5% 6.4”/i

6.6% Diseases of the Symptoms, signs,

Dkeases of the and ill-defined condtiions

respiratory system

7.9%

Injury and

poisoning

9.2%

Ofher

\“’$ms I

United States

---- Diseases of the

respiratory z?msystem*

Injury and

poisoning

France

Fiiure 9. Percent distributions of deaths by leading oauses of death: United States and France, 1961

600

500

400

200

100

0

592.7

245.6

164.1

❑ United States

❑ France

305.6

Perinatal conditions Congenital anomalies Symptoms, signs, Respiratory diseases

and ill-defined conditions

Cause of death

Injury and poisoning All other causes

Fiiure 10. Death ratea for infants under 1 year of age by leading causes of death: United Stetea snd France, 1961

14
Certain conditions originating in the perinatal period were

responsible for almost half of the infant deaths in the United

States, The U.S. infant mortality rate for perinatal conditions

was more than twice the French rate. The U.S. rate was

twice the French rate for the subcategories of anoxia and

other respiratory conditions, and of birth trauma and fetal

and neonatal hemorrhage. For the subcategory of disorders

relating to short gestation and unspecified low birth weight,

the U.S. rate was almost five times the French rate. However,

the infant rate for infections specific to the perinatal period

was almost 50 percent higher inFrance.

More infant deaths in France were attributed to symptoms,

signs, and ill-defined conditions than to any other diagnostic

category, The French infant mortality rate for the category

was almost twice the U.S. rate. The designation of an unknown

and unspecified cause was applied to infant deaths in France

at a rate more than 11 times that in the United States. It

should be noted, though, that the infant mortality rate for

sudden death, cause unknown, which includes sudden infant

death syndrome, was higher in the United States.

Congenital anomalies were a leading cause of infant death

in both countries. The U.S. infant mortality rate for congenital

anomalies was 13 percent higher than the French rate for

both sexes, 28 percent higher for females. Deaths from congenital anomalies of the circulatory system occurred at a 14-percent

higher rate inFrance, but the infant mortality rate for congenital

anomalies of the nervous system was 46 percent higher in

the United States for both sexes, 75 percent higher for females.

The differences in the rates for the other two leading

causes of infant deaths were again large. The U.S. infant

mortality rate for diseases of the respiratory system was twice

the rate in France, and the French rate for injury and poisoning

was twice the rate in the United States.

1-14 yeara

The leading causes of death for children 1–14 years of

age were similar in the two countries (table 1I). The most

important cause-of-death category in both countries was injury

and poisoning. This category was responsible for half of children’s deaths in the United States and 41.9 percent in France

(figure 11). The U.S. death rate for children I–14 years of

age for injury and poisoning was 22 percent higher than the

French rate. The U.S. death rate was 19 percent higher for

all accidents and adverse effects, 11 percent higher for trafilc

accidents, and more than 4 times the French rate for homicide

and injury purposely inflicted by other persons.

Neoplasms was the second leading cause-of-death category for children I–14 years of age in both countries. Neoplasms caused 16.5 percent of French deaths and 12.1 percent

of U.S. deaths. The French death rate was 35 percent higher

for all neoplasms, 23 percent higher for malignant neoplasms,

and 47 percent higher for leukemia.

Congenital anomalies accounted for approximately the

same rate and percent of the deaths of children 1-14 years

of age in each country. French children had a slightly higher

rate and percent of deaths for diseases of the nervous system

and sense organs. U.S. children had a slightly higher rate

and percent of deaths for diseases of the respiratory and circulatory systems.

Children’s death rates were the most different in the two

countries for symptoms, signs, and ill-defined conditions. The

French rate was over two and a half times the U.S. rate

for the whole category and for the subcategory of unknown

and unspecified cause. Symptoms, signs, and ill-defined condltions accounted for 6.4 percent of children’s deaths in France

compared with 2.4 percent of children’s deaths in the United

States.

15-44 years

Injury and poisoning was the leading cause-of-death category for people 15-44 years of age in both the United States

and France (table 12, figure 12). Injury and poisoning accounted for 62 percent of the deaths of males 15-44 years

of age in the United States, 54 percent in France. In both

4.7% 2.4%

Oiseases of the Symptoms, signs,

circulatory system and ill-defined conditions

5.0%

Oiseases of the

respiratory system +

7.1%

Diseases of the~

nervous system

and sanse organs

Y

\\ 50.2%

injury and

I anom~z poisoning )

4.3% 3.7%

Oiseases of the Oiseases of the

respiratory system circulatory system

6.4% t

Symptome, signs,

and ill-defined conditions+

7.7%

Oiseases of the ~

nervous system

and sense organs

8.5%

Congenital

anomalies

I

United States

w

France

I

Figure 11. Percentdistributionsof deathsby feeding causes of death for children 1-14 yeare of w United States and France, 19S1

15
80

70

so

50

40

30

20

10

0

Injury and poisoning Circulatory diseases Neoplasms Digestive diseases Symptoms, signs, All other causes

and ill-defined conditions

Cause of death

Fiiure 12. Death rstesfor peraons 15-44years ofsgeby leading ceuses of death: United States and Frenee, 1961

countries, approximately 38 percent of female deaths in the

age group were caused by injury and poisoning. The death

rate for injury and poisoning was 21 percent higher in the

United States. The U.S. rate was 8 percent higher for all

accidents andadverse effects and 18 percent higher for traffic

accidents. The largest difference, though, was for homicide

and injury purposely inflicted by another person. The U.S.

rate for this subcatego~ was 13 times the French rate for

both sexes, 16 times the French rate for males. In contrast,

the death rate for suicide and self-inflicted injury was 16

percent higher in France for both sexes, 31 percent higher

inFrance for females.

Neoplasms was the second leading cause-of-death category for the population 15-44 years of age in France. In

the United States, thedeath rates forneoplasms and diseases

of the circulatory system were the same, making both second

in importance as causes of death for this age group. The

French death rate forneoplasms was 33 percent higher than

the U.S. rate for males, but only 6 percent higher than the

U.S. rate for females. Themain reason forthe sex difference

was probably the 14-percent higher death rate of females

in the United States for malignant neoplasm of the breast.

The death rate for diseases of the circulatory system was

57 percent higher in the United States. Ischemic heart disease

resulted in deaths in the United States at a rate two and

a half times that in France, and the U.S. death rate for acute

myocardial infarction was 83 percent higher than the French

rate. The total death rate for cerebrovascular disease was

the same in the two countries, but the rate for males was

29”percent higher in France and the rate for females was

38 percent higher in the United States.

The French death rate for diseases of the digestive system

was 25 percent higher than the U.S. rate. The French rate

was 50 percent higher for the subcategory of alcoholic liver

disease and other cirrhosis of the liver. Symptoms, signs,

and ill-defined conditions was also an important cause-of-death

category for this age group in France. The French death rates

for this category, and for the subcategory of unknown and

unspecified cause, were over three times the rates in the

United States.

16
4!5-64 years

Diseases of the circulatory system was the leading causeof-death category for persons 45-64 years of age in the United

States, accounting for 41 percent of that group’s deaths (table 13). In France, however, circulatory diseases were responsible for only 22 percent of the deaths of persons in this

age group; and neoplasms accounted for 40 percent of French

deaths.

The U.S. death rate for all circulatory diseases was more

than twice the French rate. Among the circulatory diseases,

the U.S. death rate for ischemic heart dkease was three times

the French rate for males and five and a half times the French

rate for females. For acute myocardlal infarction alone, the

U.S. death rate was two and a half times the French rate

for males and more than four times the French rate for females

(figure 13). The U.S. death rate was also 68 percent higher

than the French rate for heart failure and ill-defined heart

disease, and U.S. females had a 29-percent higher rate for

cerebrovascular disease. Males 45–64 years of age, like males

15-44 years of age, had a higher death rate for cerebrovascular

disease in France,

The death rates for neoplasms were similar in the United

States and France, but males 45-64 years of age had a 24-

had a 33-percent higher rate in the United States. Death rates

for malignant neoplasms of the trachea, bronchus, and lung;

malignant neoplasms of the breas~ and malignant neoplasms

of the intestine, rectum, and anus all were higher in the

United States. Especially notable was the death rate for U.S.

femaies for malignant neoplasms of the trachea, bronchus,

and lung, which was more than five and a half times the

rate for French females. In contrast, the French death rate

for malignant neoplasms of the lip, oral cavity, and pharynx

was more than three times the U.S. ratq and French males

had a rate more than four times that for U.S. males.

Unlike the population 1-44 years of age, persons 45-64

years had a higher death rate for injury and poisoning in

France. French rates were 33 percent higher for accidents

and adverse effects and 77 percent higher for suicide and

self-inflicted injury.

As was the case for the age group 1544 years of age,

the death rate for those 45-64 years of age for diseases of

the digestive system was higher in France. The French death

rate for alcoholic liver disease and other cirrhosis of the liver

was more than twice the U.S. rate. The death rates for

symptoms, signs, and ill-defined conditions and the subcategory of unknown and unspecified cause were higher in France

for persons 45-64 years of age, as they were for younger

percent higher death rate for neoplasms in France; females age groups.

250.0

48

59.5

142.4

❑ United States

❑ France

54.3

33.2

16.5

250 200 150 100 50 0

76.3

Acute myocardial

infarction

Cerebrovascular

disease

Malignant neoplasm

of trachea,

bronchus, and lung

Matignant neoplasm

of lip, oral cavity,

and pharynx

Chronic obstructive

pulmonary disease

Females

Deaths per 100,000 population

u 1 I

o 50 100

Figure 13. Death ratesfor persona 45-64 yeara of age by sex and selected causes of death: United States and France, 1981
The death rate for diseases of the respiratory system was

higher for this age group, as well as younger age groups,

in the United States. Chronic obstructive pulmonary disease

was a significant cause of death for persons 45-64 years

of age in the United States; the U.S. death rate for this

condition was twice the French rate for males and more than

four and a half times the French rate for females.

65 years and over

The leading cause-of-death category for persons 65 years

of age and over in both France and the United States was

diseases of the circulatory system (table 14). The U.S. death

rate for circulatory diseases was 26 percent higher than the

French rate. As was the case for the younger age groups,

the differences in death rates were particularly large for isthree times the French rate, and acute myocardial infarction,

for which the U.S. rate was almost twice the French rate.

Death rates were 52 percent higher in France for cerebrovascu.

Iar disease and for heart failure and ill-defined heart disease

(figure 14.)

The second leading cause-of-death category for the elderly

in the two countries was neoplasms. The French rate was

24 percent higher than the U.S. rate for males, 7 percent

higher for females. Nevertheless, the death rate for malignant

neoplasm of the trachea, bronchus, and lung remained higher

in the United States, and the difference was especially large

for females, whose death rate in the United States was three

times the rate in France. The death rate for males for malignant

neoplasm of the intestine, rectum, and anus was 15 percent

higher in France, but the death rates for females for this

chemic heart disease, for which the U.S. rate was almost category were almost identical in the two countries,

822.0

Acute myocardial

infarction I

I

I 423.4

Cerebrovascular

disease

810.5

Heari failure

and ill-defined

heart disease

I

[ 504.6

c

z

% Malignant neoplasm 232.5

“6 of trachea,

$ bronchus, and lung

i%

0

Pneumonia

Accidental falls

Senility

❑ UnitedStates

❑ Franca

o 260 460 660 860

Deaths par 100,000 population

Figura 14. Death rates for persons 65 yeara of age and over by eefected causes of death Unitad States and Frmoe, 1S61

18
The third leading cause-of-death category in both countries

was diseases of the respiratory system. Unlike the other age

groups, the elderly had a higher death rate for respiratory

diseases in France. The difference was small for males, but

the death rate for females was 25 percent higher in France.

However, the death rate for chronic obstructive pulmonary

diseases was 30 percent higher in the United States, and

the U.S. death rate for pneumonia was more than twice the

rate inFrance.

The French death rate was almost twice the U.S. rate

for diseases of the digestive system, 25 percent higher than

the U.S. rate for endocrine, nutritional and metabolic diseases,

and immunity dkorders, 2.6 times the U.S. rate for injury

and poisoning, and 6.8 times the U.S. rate for symptoms,

signs, and ill-defined conditions. In the injury and poisoning

category, almost half of French deaths were from accidental

falls, for which the French rate was more than four times

the U.S. rate. Senility without mention of psychosis accounted

for 40 percent of French deaths in the symptoms, signs, and

ill-defined condhions category. The French death rate was

almost 36 times the U.S. death rate for senility.

19
Hospital use

In 1981 an estimated 37.4 million U.S. patients were

discharged after spending at least one night in a short-stay

hospital, according to data from the National Hospital Discharge Survey. These patients were hospitalizedfor a total

of 276.1 million days of care. According to the CREDES

study of French hospitalization, 7.2 million patients were

discharged after at least one night in a short-term hospital

service in 1981. They spent an estimated 79.1 million days

in these short-term services. It is important to note that because

these data are from sample surveys, a certain amount of variability in the estimates can be attributed to sampling error,

The differences in estimates highlighted in this section of

the report are those that have been found to be significant,

based on the r-test, using Bonferroni critical values for post-hoc

multiple comparisons.

Age and sex

The rates of patients discharged from short-stay hospital

services varied by age and sex in the United States and France

(table 15). The variations by age were larger in the United

States (figure 15). The discharge rate for U.S. patients of

all ages was 164.3 per 1,000 population. Rates ranged from

55.8 per 1,000 population for patients l–l 4 years of age

to more than 10 times that, 576.9 discharges per 1,000 population for patients 85 years and over. In France the discharge

8 I I 1 I

0 20 40 60 60 90

Age in years

*-.

Fiiure 15. Discharge rates for patients discharged from shoti.AAy hospitals or services by age United Ststes snd France, 1981

20
rate for all patients was 134,1 per 1,000 population, and

the range in rates was from 65.4 per 1,000 population for

patients 1-14 years to 279.9 per 1,000 population 85 years

and over, a fourfold difference.

The discharge rate was23percent higher in the United

States than in France. U.S. discharge rates were significantly

higher for several specific age groups. Patients in the United

States 45–54 years of age were discharged from hospitals

at a rate 60 percent higher than their French counterparts,

and all three age groups 65 years and over were discharged

more frequently in the United States than in France. The

U.S. discharge rate was 54 percent higher for the 65–74

year group, 71 percent higher for patients 75–84 years of

age, and more than twice the rate for French patients 85

years of age and over.

The discharge rates of U.S. males, French males, and

French females were not significantly different in 1981; However, U.S. females had a discharge rate 32 percent higher

than French females and 40 percent higher than U.S. males.

The pattern of discharge rates by age differed for males

and females in each country. For U.S. and French males,

discharge rates were below 100 per 1,000 population for patients l–l 4 years, 15–24 years, and 25–34 years of age,

then gradually increased with age (figure 16). The increases

were generally larger in the United States, so that for patients

75–84 years of age, the discharge rate for U.S. males was

82 percent higher than the discharge rate for French males.

Discharge rates for females in both countries were more

than 200 per 1,000 population for the age group 25–34 years

(figure 17). In the United States, the rate was 157.0 discharges

per 1,000 population for female patients 35-44 years and

then generally increased with age. In France the discharge

rate was down to 91.1 per 1,000 population for female patients

45–54 years of age—half the rate of U.S. females—before

it began to rise again. U.S. rates were also significantly higher

than French rates for females in the age groups 65 years

and over. The U.S. rate was 69 percent higher than the French

rate for females 65–74 years, and 65 percent higher for females

75–84 years.

The percent distributions of patients discharged from shortstay hospital services are shown by sex for four age groups

in figure 18. The distributions were much the same for females

7oo600-

500-

400-

3oo200-

\

\

\

\,

UnitedStates

P

100

\ -------

\------- ”---

I

I I t I 1 I t I I

0 10 20 30 40 50 60 70 80 90

Age in years

Figure16. Discharge rates for malesdischargedfrom short-stay hospitals or servicesby age UnitedStatesandFrance,1981

21
●

aoo .

United States

SoOc 400-

.g

ra5

E

0

0

0-

300-

5

n

83

p

g

.&

n 200-

/

----

,--

/

/

1oo-

-\\

+

1 I I I 1 I I t f

0 10 20 30 40 50 ‘ 60 70 80 90

Age in years

Figure 17. Okcharga rates for fatnaleadischarged fronr short-stay hoapitsls or services by age United States and France, 19S1

in the two countries. Almost half of all females dkcharged

were in the childbearing years, 15-44 years of age. Approximately 26 percent of female discharges were 65 years of

age and over in both countries. Patients 45-64 years of age

accounted for 18.6 percent of female discharges in France

and 20 percent in the United States. Children under 15 years

made up 6.9 percent of female discharges in the United States,

7.4 percent in France. Patients under 45 years accounted

for 43.5 percent of male discharges in the United States compared with 50.2 percent in France. Thus, patients 45 years

and over were responsible for 56.5 percent of male discharges

in the United States, 49.8 percent in France.

Rates and percent distributions of days of care are shown

in table 16 by age and sex. Days of care are the estimated

number of days patients who were discharged from short-stay

hospital services in 1981 spent in the hospital. The rate of

days of care is a measure of the total volume of hospital

use for a given population. In 1981 the total rate of days

of care was higher in France than in the United States, 1,501,9

versus 1,212.8 per 1,000 population.

The variations in the rates of days of care by age were

similar in the two countries (figure 19). The rates generally

increased with age in both countries. U.S. rates ranged from

230.3 per 1,000 population for patients 1-14 years of age

to 6,901.7 per 1,000 population for patients 85 years and

over. The range in French rates was from 497.0 per 1,000

population for patients 1–14 years of age to 6,017.9 per 1,000

population for patients 85 years and over. Unlike discharge

rates, none of the U.S. rates of days of care for specific

age groups were found to be significantly different from French

rates.

Also unlike discharge rates, the rates of days of care

were not significantly different for U.S. females, French

females, and French males. However, the rate of days of

care for U.S. males was 25 percent lower than the rate for

French males and 21 percent lower than the rate for U.S.

females.

The patterns in rates of days of care for each sex were

similar to the patterns in discharge rates. For males (figure 20), the age groups 1–14 years, 15-24 years, and 25–34

years, which had discharge rates below 100 per 1,000 population, also had rates of days of care of less than 1,000 per

1,000 population in both countries. Their rates of hospital

days, like their discharge rates, then increased with age.

Females 25–34 years of age (figure 21), who had discharge

rates of more than 200 per 1,000 population in both countries,

had rates of days of care of more than 1,100 per 1,000

population in the United States and more than 1,500 per

22
1oo80-

60-

40-

20-

0

m

United States France

Males

❑ MJaare

a over

❑ $x’

nn

United States France

Females

Figure 18. Peresnt distributionsof patianta discharged from short-stay hospitals or services by age and sex United States and France, 1981

1,000 population in France. Rates this high were not seen

again until reported for the group 45–54 years in the United

States,andthegroup55-64 yearsinFrance,

The percent distributions of days of care by age were

similar for the two sexes in the two countries (figure 22).

Patients 65 years of age and over made up from 37 to 42

percent of all days of care. The group 45-64 years of age

accounted for from 20 to 27 percent of hospital days, and

patients 15-44 years of age used 25 to 32 percent of all

days, Children under 15 accounted for only 5 to 11 percent

of all days of care.

The higher rate of days of care in France was the result

not of more frequent hospitalizations but of longer hospital

stays, The average length of stay in a short-term hospital

service was 11.2 days in France, 50 percent longer than the

average of 7.4 days in the United States (table 17).

Average lengths of stay varied threefoldby age in both

countries (figure 23). In France average stays ranged from

6.9 days for patients 15–24 years of age to 21.5 days for

patients 85 years and over. In the United States the range

was from 4. I days for children 1–!4 years to 12.0 days

for the group 85 years and over.

There were statistically significant differences in the average lengths of stay for most of the specific age groups, but

the sizes of the differences varied. Patients I–14 years, 15–24

years, 25–34 years, and 35--44 years stayed 2.2-3.5 days

longer in France, but the average stays of the group 45–~4

years were not significantly different in the two countries,

The French average lengths of stay were substantially longer

for all the age groups 55 years and over 4.7 days longer

for patients 55-64 years, 7.7 days longer for those 65–74

years, 6.4 days longer for the age group 75–84 years, and

9.5 days longer for patients 85 years of age and over.

Both male and female patients were hospitalized significantly longer in France than in the United States. The average

lengths of stay of males in France ranged from 7.0 days

for those 15–24 years of age to 17.6 days for the group

65–74 years. In the United States the range was from 4.1

days for children 1–14 years of age to 11.5 days for patients

85 years of age and over. As can be seen in figure 24,

the average stays of male patients 15–24 years were quite

similar, 7.0 days in France and 6.2 days in the United States;

but the average stay of a male patient 65–74 years was 17.6

days in France compared with 10.0 days in the United States.

The range in average lengths of stay of female patients

in France was from 6.9 days for the group 15–24 years of

age to 23,6 days for those 85 years of age and over (figure 25). In the United States average stays ranged from 4.1

days for female patients 1–14 years of age to 12.2 days

for females 85 years and over.

23
Zi

7,000 -! United States

6,000-

5,000-

4,000- /

/

/

//

,//

3,000-

/1

/1

//

,//

2,000- /’

\

1,000-

m . . ● ■ ● 4

0 10 20 30 40 50 60 70 80 W

Age in years

Fiiure 19. Ratea of days of oare for patients discharged from short-stay hoapMs or serviees by W% United States and France, 19S1

Diagnosis

Hospital use in the United States and France for specific

diagnostic categories is examined in this section of the report.

The rates and percent distributions of discharges by diagnostic

categories are compared for U.S. and French patients, followed

by comparisons of the rates and percent distributions of days

of care and average lengths of stay by diagnostic categories

for patients in both countries. Rates of discharges and days

of care and average lengths of stay by diagnostic category

are also shown separately for three age groups: 1544 years,

45-64 years, and 65 years and over. The diagnostic data

for the age group under 15 years could not be compared

because of the small number of cases in the French survey

for this age group.

The French diagnostic data were coded according to the

International Classification of Diseases,9th Revision (ICD-9).

In the United States the InternationalClassificationofDiseases,

9th Revision, ClinicalModification (ICD-9-CM) was used,

but it is identical to ICD-9 at the level of 3-digit codes

24

used here. The principal diagnosis or the one listed first on

the medical record is used in the comparison.

Data are compared for 15 of the 17 diagnostic categories

in the International Classification of Diseases. The French

data for two of the categories, diseases of the blood and

blood-fofiing organs and certain conditions originating in

the perinatal period, were insufficient for comparison. The

category of complications of pregnancy, childbirth, and the

puerperium includes females with deliveries, which are coded

to the supplementary classification in other reports from the

U.S. survey. The tables for the specific age groups include

the diagnostic categories for which the number of cases in

theFrench study were large enough to make reliable estimates.

Discharges

Leading diagnostic categories in the United States included

diseases of the circulatory system; complications of pregnancy,

childbirth, and the puerperium; diseases of the digestive system; injury and poisoning; diseases of the respiratory system;
8,000-

Unifed States

7,000-

6,000 -

5,000-

.

~

//~

.=

~

i

/

4,000- /1

g

/1

i

/1

$ 3,000-

/1

3 /

$

Q /1

\

/’

2,000- ‘,

/

/

1,000-

,------ ------- -.-0

I I { I 9 I I I i

o 10 20 30 40 50 60 70 80 90

Age in years

Figure 20. Rates of dsys of care for males discharged from short-stay hospitals or servioea by age United Ststes and France, 1981

and diseases of the genitourinary system (tables 18 and 19).

These six diagnostic categories accounted for 66 percent of

U.S. discharges. These categories made up more than half

of French discharges, and with the addition of neoplasms,

also a leading discharge category in France, 62 percent of

French discharges were accounted for.

Diseases of the circulatory system made up 14 percent

of U.S. discharges and 9.2 percent of discharges in France.

Heart disease accounted for 63 percentof the circulatorydisease dischargesin the United States but only for 26 percent

in France, The U.S, discharge rate was 89 percent higher

for the whole circulatory disease category, but it was a startling

4.5 times the French rate for heart disease (figure 26). The

death rates for diseases of the circulatory system and the

subcategory, ischemic heart disease, were also higher in the

United States (table 9).

The proportions of discharges in the category of complications of pregnancy, childbirth, and the puerperium were much

more similar, 12.5 percent in the United States and 11 percent

in France. The discharge rate for normal deliveries was almost

the same in both countries, but normal deliveries made up

more than half of the pregnancy category in France and only

38 percent in the United States.

Diseases of the digestive system accounted for 12.3 percent of dkcharges in the United States, 10.2percentin France.

The difference between the countries in discharge rates for

the digestive disease catego~ was not statistically significant.

However, the French discharge rate for acute appendicitis

was nearly four times the U.S. rate. As can be seen in figure 27, more than one of every four French discharges with

a digestive disease had the diagnosis of acute appendicitis,

but only 6 percent of digestive disease discharges were for

appendicitis in the United States.

The injury and poisoning category made up 12.I percent

25
United States

I

I I I I I I I I i

o 10 20 30 40 50 60 70 80 90

Age in years

Fwure 21. Ratea of &ya of care for famalea discharged from short.stay hospitala or aervicea by age United Statea and France, 1981

of French discharges and 9,2 percent in the United States,

but the discharge rates for the category were similar in the

two countries. The U.S. discharge rate for diseases of the

respiratory system was more than twice the French rate (figure 28), and respiratory disease discharges accounted for 9.9

percent of discharges in the United States compared with

5.1 percent in France, The discharge rate for diseases of

the genitourinary system was also significantly higher in the

United States, and genitourinary diseases made up 9 percent

of U.S. discharges versus 6.3 percent of French discharges.

There was a significantly higher rate of French discharges

for one diagnostic category, symptoms, signs, and ill-defined

conditions. This category contains conditions for which a

more definitive diagnosis could not be made. The French

discharge rate was 2.4 times the U.S. rate for this category,

and the category accounted for 4.8 percent of French discharges

but only 1.7 percent of U.S. discharges. The French death

rate for the category was more than five times the U.S, rate

(table 9).

Both males and females with circulatory disease diagnoses

were discharged more frequently in the United States. U.S.

males had a discharge rate 81 percent higher than that of

French males, and the discharge rate of U.S. females was

96 percent higher than the rate of French females for this

category (figure 29). Diseases of the circulatory system made

up 17.5 percent of the discharges of males and 11.7 percent

of the discharges of females in the United States. Circulato~

diseases accounted for 10.7 percent of male discharges and

7.8 percent of female discharges inFrance.

U.S. males and females were also hospitalized more often

for diseases of the respiratory system. The discharge rate

for males was 79 percent higher in the United States than

in France, and the rate for U.S. females was 2.8 times the

rate for French females. The percent of discharges in this

category was 11.3 for U.S. males and 7.7 for U.S. females.

Diseases of the respiratory system accounted for 7 percent

of the discharges for French males, 3.6 percent for French

females.

In addition, females were discharged more often in the

United States for diseases of the genitourinary system. U.S.

females had a rate 90 percent higher than females in France.

Diseases of the genitourinary system accounted for 10.3 per26
100

80

60

E

al

g

t’

40

20

0

United States

Males

France

❑ ☎☎✚

❑ Und:15

yeas

United States France

Females

Figure 22. Percent distributionsof cfwe of care for patients discharged from short-stay hosritals or serviees by age and sex United States and

Ffinca, 1981

cent of female dkcharges in the ?-JnitedStates and 7.1 percent

inFrance.

Besides diseases of the circulatory system and diseases

of the respiratory system, other leading discharge categories

for U.S. males were diseases of the digestive system and

injury and poisoning. These four diagnostic categories made

up 56 percent of male discharges in the United States. Almost

half of the discharges of French males were for diseases

of thecirculatory and digestive systems, injury and poisoning,

and neoplasms.

About one of every five females discharged from hospitals

in both France and the United States had a diagnosis in the

category of complications of pregnancy, childbirth, and the

puerperium. This category, along with diseases of the circulatory system, diseases of the genitourinary system, and diseases

of the digestive system, accounted for more than 54 percent

of the discharges of females in the United States, 44 percent

inFrance,

Days of care

The rates and percent distributions of days of care by

diagnostic categories are shown in tables 20 and 21. In both

countries, diagnostic categories responsible for large numbers

of days of care included diseases of the circulatory system,

diseases of the digestive system, injury and poisoning, and

neoplasms. These categories accounted for half of the days

. .

of care in the United States, 43 percent in France (figure 30).

A greater proportion of hospital days were for diseases

of the circulatory system in the United States (18.6 percent)

than in France (13.4 percent). The rates of days of care

for circulatory diseases were, however, not significantly different in the two countries (figure 31). The rate of days of

care for heart dkease, like the dkcharge rate for heart disease,

was much higher in the United States. The U.S. rate was

more than twice the French rate.

The proportions of hospital days for diseases of the digestive system, injury and poisoning, and neoplasms were not

significantly different in the two countries, and neither were

the rates of days of care for these categories. One diagnostic

category for which there were significant differences in use

was symptoms, signs, and ill-defined conditions. The French

rate of days of care was 5.5 times the U.S. rate for that

category. In France 4.4 percent of all days of care were

for symptoms, signs, and ill-defined conditions, but only I

percent of all days of care were attributed to it in the United

States. The French rate and percent of discharges were also

higher for this category, as was the French death rate.

Another difference between the two countries was for

the mental disorders category. The rate of days of care for

U.S. males was more than twice the rate of French males

for the category. Mental disorders made up 9.2 percent of

27
25-

France

/

20- /’

/

,/

/

/

------. /

/

/

/

15- /

/“”

/ United States

0

\

/

\

/

10- \

\\

\\

-----

5-

1 I 1 1 f

0 20 40 60 80 90

Age in years

all hospital days for U.S. males, but only 2.9 percent of

the days of French males.

Diagnostic categories for which large numbers of days

of care were reported were the same for males as for ail

patients. Diseases of the circulatory system, diseases of digestive system, injury and poisoning, and neoplasms together

accounted for more than half of the days of care of males

in both countries. In addition, complications of pregnancy,

childbirth, and the puerpenum was a leading category for

females in both countries. The pregnancy category together

with the other four categories made up 57.1 percent of the

hospital days for U.S. females, 48.6 percent for French

females.

Average length of stay

In the United States, average lengths of stay for the major

diagnostic categories ranged from 12,3 days for mental disorders to 3.6 days for complications of pregnancy, childbirth,

and. the puerperium (table 22). French average lengths of

stay for the major categories ranged from 16.1 days for diseases

of the circulatory system to 4.4 days for the supplementary

classification. The supplementary classification is for factors

influencing health status and contact with health services.

It includes codes for factors like exposure to communicable

diseases, personal history of malignant neoplasm, adjustment

of prosthetic device, and special examinations.

The French average length of stay was at least 2 weeks

for the major categories of circulatory, infectious and parasitic,

28

F@ure 23. Average Iengtha of stay for patients discharged from short-stay hospitals or servioes by age United States and France, 1981

and respiratory diseases. None of the stays for major categories

averaged 2 weeks or more in the United States, but the U.S.

average stays for both mental disorders and neoplasms exceeded 10days.

Among the diagnostic subcategories, French average

lengths of stay were at least 2 weeks for cerebrovasctdar

diseases and heart disease, arthropathies and related disorders,

and malignant neoplasms. Average lengths of stay were more

than 10 days in the United States for cerebrovascular diseases,

malignant neoplasms, fractures, and diseases of the central

nervous system.

Average lengths of stay of less than 5 days were reported

in the United States for the major diagnostic categories, complications of pregnancy, childbirth, and the puerperium;

symptoms, signs, and ill-defined conditions; and the supplementary classification. Within the pregnancy category, the

U.S. average stay for deliveries without complications was

only 3 days. The supplementary classification was the only

major category in France with an average length of stay of

less than 5 days, but stays were less than 8 days in France

for congenital anomalies and the pregnancy category. The

average lengths of stay for both the pregnancy categoty as

a whole (figure 32) and for uncomplicated deliveries were

significantly longer inFrance than in the United States.

French average lengths of stay were also significantly

longer than U.S. stays for diseases of the circulatory system

and symptoms, signs, and ill-defined conditions. Hospitalizations for circulatory diseases were “6.3 days longer in France,
c,-

18- France

/------

/

--------

/’

/

/’

15- //

/

/

/’

\

/’

12- \

\

/’ UnitedStates

\

\

/’

\ —---- __ /’

\

/’

\

/

/

9- \

0

\

/

\, //’

----

~~~

--- ~0

-.. /

6-

3-

1 I I I 8 I I 1 1

0 10 20 30 40 50 60 70 80 90

Age in years

Figure 24. Aver~bngths ofstayfor males dacMrg4tim sho~-sby hosp"tiIa oraeticesby~w United States and France, 1981

but French patients were hospitalized less often for the treatment of circulatory diseases. For symptoms, signs, and illdefined conditions, not only was the French average length

of stay more than twice the U.S, average, but the category

was a more frequent cause of hospital discharges and days

of care, and accounted for a larger proportion of dkicharges

and days of care in France.

Patients 15-44 years of age

The number of children under 15 years of age in the

French survey was too small to allow detailed comparisons

of children’s d~agnoses, but the hospital use of patients 15-44

years of age can be compared by diagnostic categories in

table 23. The discharge rates of U.S. and French patients

in this age group did not differ greatly for most diagnostic

categories. In both countries, categories accounting for large

numbers of d~scharges included complications of pregnancy,

childbirth, and the puerperium; injury and poisoning; diseases

of the digestive system; and diseases of the genitourinary

system. These four categories made up 63 percent of the

discharges of U.S. patients and 57 percent of the discharges

of patients in France (figure 33). Approximately one of every

eight discharges of U.S. patients and one of seven French

discharges in this age group were for deliveries without

complications,

The rate of days of care for patients 15-44 years of

age was 32 percent higher in France than in the United States.

However, the U.S. rate of days of care for mental disorders

was 2.7 times the French rate for this category. Mental disorders made up 14 percent of U.S. days of care but less than

4 percent of the days of care in France. Mental disorders;

complications of pregnancy, childbirth, and the puerperium;

and injury and poisoning were major causes of hospital days

in the United States. These three diagnostic categories together

accounted for almost half of U.S. days of care. In France,

the categories of complications of pregnancy, childbirth, and

the puerperium; injury and poisoning; and diseases of the

digestive system together made up half of all hospital days.

Patients 15-44 years of age were hospitalized 2.4 days

longer in France than in the United States. The French average

stays for that age group ranged from 11.0 days for diseases

of the musculoskeletal system and connective tissue to 4.9

days for the supplementary classification. In the United States,

the range was from 12.0 days for mental disorders to 3.2

days for the supplementary classification. Besides mental disorders, U.S. average stays exceeded a week for the diagnostic

category of neoplasms and the subcategory of fractures. In

France, the average stay exceeded a week for the majority

of diagnostic categories.

In addition to the supplementary classification, U.S. stays

29
France

I

I I 1 I 1 1 I 1 t

o 10 20 30 40 60 80 70 60 90

Age in years

Fiiure 25. Aversge lengths of stsy for fernskesdischarged from short-stsy hoapWs or servioes by w United Ststes sncfFmnee, 1SS1

were less than 4 days for the pregnancy category as a whole

and for both major subcategories shown in the table—abortion

and pregnancy with abortive outcome, and deliveries without

mention of complications. An average U.S. stay of less than

4 days was also reported for symptoms, signs, and ill-defined

conditions. The only French stay of less than 4 days was

2.7 days for abortion and pregnancy with abortive outcome,

which was almost the same as the U.S. average stay for

the diagnosis.

Patients 45-64 years of age

Patients 45-64 years of age were hospitalized more frequently in the United States than in France. The U.S. discharge

rate for all conditions was 191.6 per 1,000 population, which

was 44 percent higher than the French rate of 133,4 per

1,000 population (table 24). Differences in discharge rates

were particularly large for diseases of the circulatory and

digestive systems. The U.S. rates for these categories were

more than twice the French rates (figure 34). On the other

30

hand, the discharge rates for neoplasms were quite similar

in the two countries.

Diseases of the circulatory system, diseases of the digestive system, and neoplasms accounted for 46 percent of the

discharges of patients 45-64 years in the United States. Circulatory diseases alone were responsible for more than one

in every five U.S. discharges (21 percent). In France, circulatory diseases accounted for only about one in nine of the

discharges (11 percent) of this age group. Neoplasms, injury

and poisoning, diseases of the circulatory system, and diseases

of the digestive system together made up 48 percent of the

French discharges.

Although ;he rate of days of care for the 1544-year

age group was higher in France, the rates of days of care

of patients 45-64 years were not significantly different in

the two countries. In the United States, diseases of the circulatory system were responsible for more than 1 of every 5

hospital days (22 percent) ,of this age group. About 1 of

every 6 hospital days (16 percent) were for circulatory diseases

in France. Diseases of the circulato~ and digestive systems
23.0

❑ United States

❑ France

14.4

Diseases of the Heart disease

circulato~ system

Fwure 26. Oischsrge rates for patients discharged from short-stay

hospitals or services for dmeaaes of the circulatory system and heart

dmease United States and France, 1961

and neoplasms together accounted for almost half of the hospital days of U.S. patients 45-64 years. Almost half of the

hospital days of French patients in this age group were for

these same three categories plus mental disorders.

The average length of stay for patients 45-64 years of

age was 3.7 days longer in France than in the United States.

Among the leading diagnostic categories shown in tabIe 24,

French average lengths of stay ranged from 16.5 days for

mental disorders to 7.4 days for injury and poisoning. Besides

mental disorders, average stays of more than 2 weeks were

reported in France for diseases of the circulatory system (16.4

days) and endocrine, nutritional and metabolic diseases, and

immunity disorders (15.6 days).

No lengths of stay of 2 weeks or more were reported

in the United States. The range in lengths of stay for the

major diagnostic categories was from 11.9 days for mental

disorders to 7.6 days for diseases of the digestive system.

Besides mental disorders, only neoplasms and its subcategory,

malignant neoplasms, required stays of 10 days or more in

the United States.

Patients 65 years and over

Patients 65 years of age and over, like those 45-64 years,

were hospitalized more frequently in the United States than

in France (table 25). The U.S. discharge rate of 391.4 was

63 percent higher than the rate for France of 239.6. The

elderly were also like patients 45-64 years in that the U.S.

discharge rates for diseases of the circulatory system and

diseases of’ the digestive system were more than twice the

French rates (figure 35).

Unlike the 45-64 year age group, the discharge rate for

patients 65 years and over was significantly higher in the

United States for neoplasms. The U.S. rate for the category

as a whole was 41 percent higher, and the discharge rate

for malignant neoplasms was 83 percent higher in the United

States.

The diagnostic categories diseases of the circulatory system, diseases of the digestive system, and neoplasms together

were responsible for 52 percent of the discharges of U.S.

patients 65 years and over. These three categories and injury

and poisoning together made up 52 percent of the discharges

of French patients” 65 years and over. Circulatory dk.eases

Acute appendicitis

ph

United States France

Oiseases of the digestive system

Figure 27. Discharges from short-stay hospitala or services with acute appandwitis as a proportion of discharges with dmeases of the d~ative system.

United States and France, 1981

31
25

201

I 15.0 lAf4

❑ UnitecfStates

❑ t%arw?

Oiseases of the Oiseases of the Symptoms, signs,

respiratory system genitourinary and ill-defined

system conditions

Diagnostic category

Fwura 28. Discharge rates for patients diaehsrged from short-stay

hospitals or serwieas by seleeted diagnostic estegorie% UnitedStates

and Frsnee, 1981

alone accounted for 29 percent of U.S. discharges, 22 percent

of French discharges.

Diseases of the circulatory system was the leading cause

of hospital days for the elderly in both countries. Circulatory

diseases accounted for 30 percent of U.S. days of care, 21

percent of French days of care. In the United States, circulatory

diseases, together with diseases of the digestive system and

neoplasms, were responsible for 54 percent of the days of

care for patients 65 years and over. In France, circulatory

diseases, neoplasms, injury and poisoning, and diseases of

the respiratory system jointly made up 52 percent of the hopsital

days of the elderly. The total hospital use of the elderly,

that is, the rate of days of care for all conditions, was similar

in the two countries.

The average length of stay of patients 65 years and over

was 6.6 days longer in France than in the United States.

The range of French lengths of stay for the main diagnostic

categories was from 23.6 days for diseases of the respiratory

system to 14.3 days for diseases of the nervous system and

sense organs. In the United States the range was from 14,1

days for mental disorders to 5.9 days for diseases of the

nervous system and sense organs. A relatively short average

length of stay, 14.1 days, was reported in France for the

subcategory of fracture of the neck of the femur (hip fracture).

The United States had a long length of stay, 20.8 days,

for fracture of the neck of the femur.

Marital status

Discharge rates and rates of days of care are shown in

table 26 by marital status for patients 15 years of age and

over. In France the married category includes persons

cohabitating but in the United States it does not. Separated

refers to legal separations in France but also includes other

persons permanently or temporarily separated because of marital discord in the United States. The marital status of 6 percent

of U.S. discharges and 7.2 percent of French discharges was

not reported.

For the United States, estimates of the population in each

marital status catego~ were available only for the civilian

noninstutionalized population. The civilian resident population

was used to compute U.S. rates elsewhere in this report.

Use of the civilian noninstitutionalized population had the

largest effect on the rates for the population 65 years and

over, which was most likely to be residing in an institution,

usually a nursing home. The rates based on the civilian noninstitutionalized population were 6 percent higher, on average,

than the rates based on the civilian resident population for

the population 65 years and over. The distribution of the

U.S. population under 15 years of age by marital status was

not available, but almost all children under 15 years would

be expected to be single.

More than 90 percent of the population 15-44 years of

age in the United States and 96 percent in France was either

married or single. In the United States the discharge rate

for the married population 15-44 years was 157.3, 50 percent

higher than the rate for single persons of 104.0 (figure 36).

The U.S. rate of days of care was also 28 percent higher

for married than for single persons, probably reflecting more

hospital use by the married population for care related to

childbearing. In France the discharge rate was 138.9 per 1,000

population for the married category compared with 94.4 per

1,000 for the single population, and the rates of days of

care were 1,069.5 per 1,000 for married persons, 717.4 per

1,000 population for single persons. The differences between

the United States and France in hospital use rates for the

marital status categories were not statistically significant.

The discharge rate for patients 45-64 years of age (figure 37) was 44 percent higher in the United States than in

France. Married persons were discharged at a rate 52 percent

higher in the United States. The discharge rate of the single

population was 307.6 per 1,000 population in the United

States compared with 189.8 per 1,000 population in France,

and widowed persons had a discharge rate of 206.8 per 1,000

population in the United States, 124.4 per 1,000 population

inFrance.

Unlike the younger age group, the U.S. single population

45-64 years of age had a discharge rate 80 percent higher

than the married population, and its ra~e of days of care

was more than twice the rate of the married population. Single

people 45-64 years also had a discharge rate and a rate of

days of care approximately 50 percent higher than people

who were widowed in the United States. The patterns were

similar in France, but the differences in use rates by marital

status were not large enough to be statistically significant.

32
23,9

Males

22.2

Females

Oiseases of the circulatory system

15.4

❑ LlnitedStates

n France

u

14.7

Females

Oiseasesof the respiratory system

Fbure 29. Dbchartte ratea for Patients dischanted from short-stay homitals or servieea for diseases of the circulatory and rewiratory .- sw+temaby sex

United States and France, 198i

The discharge rate for the population 65 years and over

(figure 38) was 74 percent higher in the United States than

in France, Married persons 65 years and over had a 46 percent

higher discharge rate in the United States, and the U.S. rate

of the widowed population was almost twice the rate in France.

As was the case for the population 45-64 years, single persons

65 years and over had a higher discharge rate and rate of

days of care than did married persons in the United States.

The discharge rate and rate of days of care were also higher

in the United States for the widowed than for the married

population,

These differences may be related, in part, to the use

of the civilian noninstitutionalized population to compute use

rate in the United States. Widowed, divorcedand separated,

and especially single people are more likely to be admitted

to nursing homes in the United States than are married people

65 years of age and over (NCHS, 1987). Thus, a smaller

proportion of persons without spouses than of married people

in this age group would be counted in the civilian noninstitutionalized population, and the rates based on this population would be somewhat inflated for the nonmarried groups.

However, the same factors that lead persons 65 years of

age and over without spouses to be more likely to enter

nursing homes (especially the lack of others at home to care

for them) could also increase their likelihood of hospitalization.

It should also be noted that the hospital use rates for

the single population 65 years and over in France, which

are particularly low, are based on only21 sample cases.

Percent distributions of discharges and days of care by

marital status are presented for all age groups in table 27.

Patients who were married made up about half of all discharges

and days of care in both France and the United States (figure 39). Single patients accounted for about one in every

four or five discharges and days of care in both countries.

U.S. and French widowed patients were responsible for a

little over 10 percent of all discharges, but over 18 percent

of days of care. The proportions of discharges and days of

care for U.S. patients who were divorced or separated were

approximately three times those for French patients in these

categories, 6.3-6.9 percent versus 2.0-2.2 percent.

Not surprisingly, single patients accounted for almost all

the discharges and days of care of the age group under 15

years in both countries. By the ages of 1544 years, though,

over half of discharges and days of care were for married

patients. Single patients were responsible for about 30 percent

of the dkcharges and days of care of patients 15-44 years.

Just over two-thirds of the discharges and a little less

than two-thirds of the days of care for the group 45-64 years

of age were for married patients in the two countries. Single

patients in this age group made up 7.6 percent of U.S. dis33
60

1

404 Imz% 1 ‘cop’asms 1

I

I ‘&/“ “’.\\ gyj -\\

30

Diseasesof “

the digestive

system 1

Oiseases of

the circulatory

system

o

United Statas France

250

200

c

,g

m

5

n

0

n 150

0

8.

Z

a.

al

g

100

5

In

~

c1

50

0

225.8

~ UnitedStates

~ France

135.6

Oiseases of the

circulatory system

Heart disease

F~ure 31. Rates of daya of eere for patienta dischargedfrinn short-stay

hosoitefsor aetvices for diseases of the circulstorv svstem and heart

disease United States and Frsnce, 1981 - -

Fiiure 30. Percent of daya of oare for selected diagnostic categories for

patients discharged from short-stay hospitals or serviees: United States

and France, 1981

charges compared with 12.4 percent of French discharges,

and had 8.9 percent of U.S. days ofcare versus 19.8 percent

of the days of care in France. Widowed patients accounted

for 6-10 percent of both discharges and days of care.

Married patients made up a little less than half of discharges and days of care for the group 65 years of age and

over in France and the United States. Widowed patients accounted for nearly 40 percent of each, and single patients

were also responsible for similar proportions, 5–8 percent,

of discharges and days of care in the two countries.

The average lengths of stay of French patients were significantly longer for most of the marital status groups (table 28, figure 40). Married patients stayed in French hospitals

57 percent longer than in U.S. hospitals. The average length

of stay for single patients was 54 percent longer in France,

andFrench widowed patients stayed 66 percent longer.

In both France and the United States, widowed patients,

most of whom were 65 years of age and over, had longer

average lengths of stay than patients in the other marital

status categories. The lengths of stay of the other marital

status categories in France were not significantly different.

The shortest average stay in the United States was for single

patients, mostofwhomwereyoung.

It is important to note, however, that within specific

age groups, married U.S. patients generally had shorter average

lengths of stay than patients without spouses. Married patients

were hospitalized for 15–25 percent less time on average

than single, widowed, or divorced or separated patients 15-44

years of age. For the group 45-64 years of age, average

hospitalizations of married patients were 16-19 percent shorter

than the average stays of patients without spouses. Married

patients 65 years of age and over had a 20 percent shorter

average stay than single patients and a 13 percent shorter

average stay than patients who were widowed,

Deposition

The percent distributions and average lengths of stay by

disposition of patients are shown by the patient’s age in table 29. The homeh-outine category consists of patients who

returned to their place of residence after discharge. As well

as patients returning to private homes, the category includes

patients discharged to nonmedical residential facilities, such

as prisons, orphanages, and homes for the elderly. Transfers

refer to patients transferred to other hospitals or long-term

health care facilities (nursing homes). In France, patients transferred from a short-term department to a medium or long-term

care department (such as a psychiatric, chronic, convalescence,

or rehabilitation department) within a hospital are also included

in the category. Deaths are patients who died during an inpatient hospital stay, and the other/not stated category includes

patients whose destinations were unknown or did not match

the listed categories. For the United States, patients who left

the hospital against medical advice were included in the other

34
12

1

❑ United States

m France

u

I

10.3

h I

10

8 1 7.6

Complication of Symptoms,

pregnancy, childbirth, and signs, and

the puerperium ill-defined conditions

Diagnostic category

Figure 32. Average fengtha of stay for patients discharged from ahortatay hoopitalaor aervicea by selected diagnostic oategone%

Untied States and France, 1981

catego~, but these patients accounted for only 0.7 percent

of all discharges,

In both France and the United States, more than 80 percent

of patients were dkcharged to their place of residence. The

proportion of discharges in the home/routine category was

reported to be higher in France, but this was probably because

of the larger other/not stated category in the United States.

The similarity in the average lengths of stay of the homelroutine

and other/not stated categories in the United States suggests

that most U.S, patients whose dispositions were not known

were likely to be discharged to their place of residence. Among

U.S. discharges whose dispositions were known, 92 percent

were in the home/routine category,

French patients were twice as likely as U.S. patients

to be reported as transfers, which did not appear to be greatly

affected by the larger U.S. other/not stated category. Transfers

made up only 4.5 percent of the U.S. discharges whose dispositions were known. The larger proportion of transfers in France

probably resulted in part from the definitional difference, but

it also may reflect a greater availability of an intermediate

level of hospital care in France between acute care and being

discharged home.

70-

60-

50-

40-

30-

20-

lo0

I I

genitourinary

svstem I I

F’- “

I i

F

1

–—------..

Dkeases of the

digestive system

: ---

----- ___

Injury

and

poisoning

---

--<

----

I

Complications

of pregnancy,

childbirth, and

1

the puerperium ,

United States France

F~ure 33. Percents of discharges for selected d~noatii categories for

patienta 15-44 yeara of age discharged from shott-stay hospitals or

services United States and France, 1981

The proportion of patients who were discharged dead

was very similar in the two countries. Patterns in patient

disposition by age were also similar. In general, the percent

of patients discharged to their place of residence decreased

with age (figure 41) while the percent transfemed or discharged

dead increased with age. The percent transferred was significantly higher in France than in the United States for patients

15-44 years and 45-64 years of age, but the difference in

the proportions of patients 65 years and over who were transferred was not statistically significant.

Variations in average lengths of stay by disposition were

similar in the two countries. In both, stays were longer for

transferred patients and patients discharged dead than for the

patients in the home/routine category (figure 42). This is

partly due to differences in the ages of patients with different

dispositions. More than half of all patients discharged to their

usual place of residence were under 45 years of age in both

countries. Approximately 70 percent of deaths in the United

States and 76 percent in France were patients 65 years and

over. Most transfers, 68 percent, were also 65 years and

35
❑ UnitedStates

❑ France

39.3

Oiseases of

the circulatory

system

28.6

Oiseases of

the digestive

system

Diagnostic category

20.2

Neoplasms

Fiiure 34. Oiaeharge ratea for patients 4544 yeara of age dkharged

from short-stay hoapitala or services by seleeted dwnostie eategorfe.x

United Statea and France, 1981

over in the United States. In France, 43 percent of transfers

were 65 years and over.

“There were, however, ‘significant differences in average

lengths of stay by disposition within specific age groups.

In each of the four age groups the average length of stay

for U.S. patients was lower for the home/routine category

than for the transfer or death categories. Transferred patients

in the United States also had significantly shorter average

stays than U.S. patients discharged dead, when the patients

were under 65 years of age. The average lengths of stay

of U.S. transferred patients increased significantly with age,

but the average stay of U.S. patients discharged dead did

not.

Hospital characteristics

The distributions of discharges and days of care by bed

size categories are shown in table 30 for each of four age

groups. The distributions differ in the two countries. In the

United States, approximately three fourths of all discharges

and days of care were accounted for by hospitals with 120-799

beds, whereas hospital use was somewhat more evenly divided

by bed size categories in France (figures 43 and 44).

An especially large difference in the patterns of use was

found for hospitals with 1,400 beds or more. These hospitals

accounted for almost a third of the discharges and over a

fourth of the days of care in France, but less than one percent

125

1

❑ United States

111.5 ❑ France

Neoplasms Oisaases of Oiseases of

the circulatory the digestive

system system

Diagnostic category

Fiiure 35. Diaehargeratesfor patients 65 yeara of age and over

d~harged from short-stay hos@afs or aerviees by aeleeted disgnoatk

eategorietx United States and France, 1881

of the discharges and days of care in the United States. This

difference was also seen in the distribution of short-stay hospital beds in the two countries (see table 7). About a fourth

of French beds were in hospitals with 1,400 beds or more

but only one percent of U.S. short-stay beds were in hospitals

of this size. Likewise, a higher proportion of French short-stay

hospital beds and French discharges were in hospitals with

800-1,399 beds. The percents of days of care in this bed

size category were, however, very similar in the two countries.

The proportions of discharges and days of care in U.S.

hospitals with 120-399 beds were more than twice the proportions in this category in France. In addition, the proportions

of discharges and days of care for the category of 400-799

beds were about 50 percent higher in the United States. The

percents of short-stay hospital beds in these two categories

were also substantial]y higher in the United States.

The distributions of discharges and days of care by bed

size categories were generally similar for the four age groups

within each country. The percents of discharges and days

of care in hospitals with 120-399 beds in the United States

were generally two to three times the percents in France.

Hospitals with 1,400 beds or more accounted for a fourth

to a third of the discharges and days of care of each French

age group, and for less than one percent of the use of each

age group in the United States.

Average lengths of stay by bed size and age are shown

in table 31 for the United States and France. Differences

36
❑ UnitedStates

❑ France

Total

143

15-44

years

o 25 50 75 100 125 150 175

Discharges per 1,000 population

Figure 36. Discharge rates for patients 15-44 years of age dischsrgad

from short-stay hospitals or services by marital statusx United States and

France, 1981

States

Totsl

45-64

years

Married

$

~

,~

2 8

Single

207

Widowed

~

o 350

Discharges per 1,000 population

Figure 37. Discharge rates for patients 45-64 yesrs of age discharged

from short-stay hoapitsls or services by msritsl status: United States snd

Frsnce, 1981

❑ United States

l_J France

Total

416

65 years

and over

I I

240

I

349

Married

U23’

I

154

I

I

444

Widowed

o 100 200 300 400 500 600

Discharges per 1,000 population

F~ure 38. Oischarge retes for patienta 65 yeara of age and over

dmharged from short-stay hospitals or services by marital statu=

United States and France, 1981

between the countries in lengths of stay were particularly

large for the hospitals with 50-119 beds and those with 120-

399 beds (figure 45). Hospitals with 50-119 beds had average

stays 91 percent (5.8 days) longer in France than in the United

States. Similarly, the average length of stay for hospitals

with 120-399 beds was 88 percent (6.4 days) longer in France.

There was also a statistically significant difference in the

average lengths of stay of hospitals with 400-799 beds, the

French hospitals this size having an average stay 51 percent

(4. 1 days) longer than the U.S. hospitals. The average lengths

of stay for the two largest bed size categories, 800-1,399

beds and 1,400 beds or more, were more similar in the two

countries.

The distributions of discharges and days of care by hospital

ownership, like the d&ibutions by bed size categories, were

quite different in France and the United States (table 32).

As with the bed size differences, the variations in hospital

use by ownership reflected the different patterns in the distribution of short-stay hospital beds in the two countries.

In the United States, the majority of short-stay hospital

beds, 63.9 percent, were located in private nonprofit hospitals

(table 6). These hospitals accounted for more than 70 percent

of U.S. discharges and days of care (figures 46 and 47).

The nonprofit hospital was the least common ownership category in France, containing only 10.8 percent of all short-stay

beds, 10.1 percent of discharges and 15.3 percent of days

of care.

37
Unknown

Oivorced or 6.0°A

separated

6.3% \

50.7%

United States

Divorced or

separated

Unknown 2.2%

7.2%

France

Figure 39. Percent distrfbufionsof patients discharged from short-stay hoapifafaor aerviees by marital status: United States and France, 1981

Total

Married

Single

Widowed

Oivorced or

separated

❑ United Skates

❑ France

11.2

0.8

I I

9.4

18.1

10.0

0 3 6 9 12 15 18 21

Average length of stay in days

F@re 40. Average lengths of stay for patients discharged from shortstey hospitals or services by meritsl stetu$ United Stetea snd

Franoe, 1981

1oo90-

E

S

60-

S

o.

70-

/

/

------~,

\

United States

o 10 20 30 40 50 60 70 80

Age in years

F@ure41. Pereent of patients discharged home from short-stay hospitals

or services by age United States and France, 1981

The majority of French short-stay hospital beds, 64.8

percent, were found in public hospitals. Public hospitals also

reported the majority of French discharges, 62.2 percent, and

French days of care, 57.9 percent. In the United States, public

hospitals held only 27.6 percent of beds and were responsible

for only about a fifth of discharges and days of care.

The proportions of discharges and days of care in private

for-profit hospitals in France were three times the proportions
Routine

dischargeal

discharged

home 10.4

❑tJnitedStates

m France

u

Transfera

17.3

Deaths

.7

0369121518 2124

Average length of stay in days

Figure 42. Average lengths of stsy for pstiente diaehsrged from shortstsy hospitals or services by disposition: United Ststes end France, 1981

in these hospitals in the United States. The French private

for-profit hospitals accounted for more than a fourth of discharges and days of care and slightly less than a fourth of

short-stay beds. Only about 8 percent ofdkcharges and days

of care, and 8,5 percent of beds were in private for-profit

hospitals in the United States.

The distributions of discharges and days of care by ownership categories were much the same for each age group within

each country. The majority of discharges and days of care

for each age group were in private nonprofit hospitals in

the United States and in public hospitals in France. One age

variation was noted for French private for-profit hospitals.

Less than 20 percent of the discharges of children under

15 years and of the elderly 65 years and over were in the

private for-profit hospitals in France, but more than 30 percent

of French patients 15-44 years and 45-64 ‘years were discharged from these hospitals. French patients 15-44 years

were the only age group with less than 10percent of discharges

in private nonprofit hospitals. Patients 45-64 years were the

only age group in France with less than 60 percent of dkcharges

in public hospitals.

French patients stayed longer than U.S. patients in all

three categories of hospitals (figure 48). The difference was

particularly large for the private nonprofit hospitals where

the French average length of stay was more than twice the

U.S. average stay. The average length of stay for public

hospitals was 50 percent longer in France than in the United

States. French private for-profit hospitals had average stays

41 percent longer than the U.S. hospitals in this category.

Source of payment

The sources of payment for hospitalizations in the United

States and France are shown in table 33. The U.S. statistics

are for the principal expected source of payment, which is

usually reported at the time of admission. The actual source

of payment may not always be the same as the expected

source, For example, a patient admitted to a hospital after

an accident may cite private insurance as the expected source

of payment when, in fact, Workmen’s Compensation may

ultimately pay the bill.

Private insurance, which consists of Blue Cross and other

private or commerical insurance, was the expected principal

source of payment for more than half of U.S. hospitalizations

(figure 49). Medicare, a government insurance program that

primarily provides health insurance protection to persons 65

years and over, was the principal source of payment for almost

30 percent of all U.S. hospitalizations. Nearly half of the

patients with Medicare also reported having private insurance

1,400 beds or more

0.5%

Less than 50 beds%

5.670

United States

Less than 50 beds

7.4%

--1,393 ~ds

7.6%

France

Figure43. Percent distributions of patients discharged from short-stay hoapitek or aenriees by bed size United States and France, 1S81

39
1,400 beds or more

0.5”A

Less than 50 beds% 800-1,399 beds

4.4%

United States

Less than 50 beds

5.7?0

+

beds

Fqure 44. Peroent distributions of days of care for patients discharged from short-stay hospitals or services by bed size United States and Franoa, 1981

. . .. . .-. . . . . . .

❑ United States

All sizes ,1, ❑ France

Less than

50 beds

8.4

I

J

50-119

beds

12.2

120-399

beds

13.7

400-799

beds

12.1

800-1,399

beds

1,400 beds

or more .2

-

0 10 15

Average length of stay in days

Fwure 45. Average Iengtha of stay for patients diaeharged from shortsfsy hospitals or senrices by bed size United States and France, 1981

40

to cover Medicare copayments. Medicaid was cited as the

secondary source of payment for another 11 percent of the

Medicare patients.

Medicaid is a government health insurance program that

provides benefits to low-income persons in the United States.

Medicaid was the principal expected source of payment for

9 percent of all U.S. discharges. The major share of hospital

costs was expected to be paid by the patient or family for

about 5 percent of hospitalizations. Patients with other sources

of payment also could have out-of-pocket expenses for hospital

care. In all, U.S. patients paid about one-tenth of the total

costs of hospital care directly in 1981 (Gibson and Waldo,

1982).

The only significant variation in average length of stay

by source of payment in the United States was between Medicare and non-Medicare patients. The stays of Medicare patients

were 4-5 days longer, on average, than the stays of patients

with other sources of payment. This was the result of differences in the age of patients in these categories. Almost all

Medicare patients were 65 years and over, but almost all

patients in other payment categories were under 65 years

of age.

The primary source of payment for almost all French

hospitalizations was the sick fund, the compulsory national

health insurance program of France. In 1981, all of the costs

of hospitalization were covered by the sick funds for 63 percent

of French patients. Included in this group were maternity

patients, who made up 9.2 percent of the total, and patients

with work-connected injuries or illnesses that began at work,

who accounted for 2.2 percent of all discharges. Another

51.6 percent of French patients qualified for 100percent coverage of hospital costs because they had a long-term disease,

such as tuberculosis, heart disease, cancer, or mental illness,

or because they had limited means. The sick fund also provides
Private for-profit hospitals

7.9%

21.5%

United States

Private nonprofit hospitals

9.9%

France

Figure 46. Percent distributions of patients discharged from short-stay hospitsls or services by ownership of hospitals United States and France, 1981

I

Private for-profit hospitals

8.1%

Private nonprofit hospitals

I4.e76

United States France

Figure 47. Percent distributionsof deys of care for patients discharged from short-etay hospitals or services by ownership of hospitals: United States snd

Frence, 1981

100 percent coverage of all major surgery, other expensive The usual copayment was 20 percent of the costs. About

treatments, such as cobalt therapy and hemodialysis, and hospi- half of those charged with a copayment, 17.2 percent of

tal stays after the thirtieth day, the total, had private insurance to cover costs not reimbursed

A proportion of the costs of the first 30 days of hospitaliza- by the sick fund. Thus, the copayment was fully applicable

tion were charged to about a third of French patients in 1981. to only 15.4 percent of discharged patients.

41
Private

for-profit

hospitals

Public

hospitala

❑ United Statea

France

16.7

1 1

I 1 , I

o 5 10 15 20

Average length of stay in days

F@.!re 48. Average lengths of stay for patients discharged from shortstay hospitals or services by ownership of hoepitel~ United States and

Frsnce, 1981

Gther and

not slated Workmen’s compensation

59!0

\

2%

United States France

Fiiure 49. Percent distributions of patients d-barged from short-slay hoapitafs or services by aoutvs of payment United States and France, 1981

42
Summary

The hospital systems in France and the United States

differed in several ways. The supply of hospital beds was

higher in France in all hospital services and in short-stay

services. Most French hospital beds were in public hospitals,

and the second most common were beds in private for-profit

hospitals. In the United States, most hospital beds were in

private nonprofit hospitals; private for-profit hospitals contained a much smaller proportion of beds than the other ownership categories. French hospitals were also more extreme in

size than U.S. hospitals. A larger proportion of French than

of U.S. hospital beds were in the small hospitals with less

than 120 beds and in the very large hospitals with 1,400

beds or more, Two-thirds of U.S. hospital beds were in

medium-sized hospitals ( 120-799 beds).

The majority of U.S. hospitalizations had private insurance

as the principal expected source of payment, but some out-ofpocket expense was likely for most patients. The majority

of French hospitalizations were paid for entirely by the sick

fund. Comparison of national health expenditures shows a

much higher rate of expenditures for institutional care in the

United States, which may suggest that U.S. hospital care

is more technologically intensive than French care.

Another important difference is that U.S. hospitals are

generally open-staffed; they allow office-based private physicians to admit and treat patients. The public hospitals in

France, which account for most hospital care, have closed

staffs. Only hospital-based physicians can admit and follow

patients, The organization of long-term care also differs in

the two countries. A larger supply of long-term care beds

was found in hospital institutions in France than in the United

States. Some of the types of patients treated in nursing homes

in the United States probably would be cared for in these

long-term hospital services in France.

Besides the variations in hospital systems, there were

notable differences in the populations of the two countries.

The population was older in France. Greater proportions of

the French were 65–74 years of age, 75–84 years of age,

and 85 years of age and over. The life expectancy of the

population at birth was similar in the two countries, and

the leading causes of death in both were diseases of the

circulatory system and neoplasms. However, the death rate

was higher in the United States for circulatory diseases, especially ischemic heart disease. The French death rate was higher

for neoplasms, in spite of a higher rate for malignant neoplasms

of the trachea, bronchus, and lung in the United States.

U.S. death rates were also higher for the population under

65 years of age for diseases of the respiratory system, and

although the French death rate was higher for persons 65

years of age and over, even for this age group the U.S.

death rate was higher for chronic obstructive pulmonary disease. The death rate for diseases of the digestive system

was higher in France, in large part because of higher French

rates for alcoholic liver disease and other cirrhosis of the

liver. French death rates were much more likely than U.S.

deaths to be assigned to the category of symptoms, signs,

and ill-defined conditions, and the cause of many of these

deaths was reported as entirely unknown and unspecified.

The death rates for injury and poisoning were higher

in the United States for the populations 1– 14 and 15-44 years

of age, who died more often as the result of traffic accidents

and at a much higher rate from homicide. The populations

under 1 year and 45 years of age and over died more frequently

from injuries and poisonings in France. The death rates for

these age groups were higher for all types of accidents, especially accidental falls for the elderly. French death rates were

also higher than U.S. rates for suicide.

Despite these differences, there were similarities in the

hospital use patterns in France and the United States. For

instance, age had similar effects on hospital use in both countries. Rates of discharges and days of care showed U-shaped

curves, elevated for infants, low for children, and climbing

with age with high rates for the elderly.

Major diagnostic categories were generally similar in the

two countries. Diseases of the circulatory system and neoplasms were leading causes of hospital days in both countries,

and were leading discharge diagnoses for patients 45 years

of age and over. Diseases of the digestive system was a

major diagnostic category for discharges and was one of the

main causes of days of care for both sexes and each of the

three age groups compared. Complications of pregnancy,

childbirth, and the puerperium was a leading discharge diagnosis and cause of hospital days for females and for the

group 1544 years of age in each country. Injury and poisoning

was a leading discharge diagnosis and cause of hospital days

in the two countries. In the United States, however. it was

primarily important for patients 1544 years of age. It was

a leading diagnostic category for all three of the age groups

compared inFrance.

The distributions of hospital use by age and marital status

were very much alike in the two countries. Almost all hospital

discharges and days of care in the group under 15 years

of age were for single patients. More than half of discharges

43
and hospital days for the group 1544 years of age were

for married patients, and approximately 30 percent of the

hospital use of that age group was by single patients. Approximately two-thirds of the hospital use of patients 45-64 years

of age in each country was by married patients. For the

elderly, 65 years of age and over, both the married and

widowed patients were major hospital users.

More than 80 percent of the patients in both countries

were discharged to their place of residence. The proportions

of patients discharged dead were very similar in the two

countries, and in both countries the proportion of patients

discharged to their place of residence declined with age. The

percent of patients transfemed and discharged dead increased

with age in both countries. The average lengths of stay for

patients discharged dead and transferred were longer in both

countries than the average stays of patients discharged to

their usual place of residence.

The distributions of discharges and days of care by hospital

size and ownership categories were similar in that these distributions followed the distributions of beds in each country.

Thus, in France more than half of discharges and days of

care were in hospitals with less than 120 beds and 1,400

beds or more. In the United States, almost 90 percent of

discharges and days of care were in hospitals with 120-799

beds. In France the majority of discharges and days of care

were in public hospitals, In the United States the majority

were in private nonprofit hospitals.

Among the differences in the hospital use patterns was

the higher U.S. discharge rate. In particular, females and

patients 45 years of age and over had significantly higher

discharge rates in the United States. The rate of days of

care, however, was higher in France, the result of a 50 percent

longer average length of stay for French patients. Rates of

discharges and days of care did not differ by sex in France,

but both rates were higher for females in the United States.

The differences in discharge rates were particularly large for

elderly patients; the U.S. rate was twice the French rate for

those 85 years of age and over. An especially large difference

in average lengths of stay was the 85 percent longer stay

for children 1–14years of age in France.

The discharge rate for diseases of the circulatory system

was significantly higher in the United States, and the U.S.

rate for heart disease was 4.5 times the French rate. Both

U.S. males and females had higher discharge rates for circulatory diseases, and the U.S. discharge rate for patients 45

years of age and over with circulatory diseases was twice

the French rate. Even though the average length of stay for

diseases of the circulato~ system was longer in France, the

U.S. rate of days of care for heart disease was twice the

French rate.

Discharge rates were also higher in the United States

for diseases of the respiratory system and genitourinary system,

and U.S. patients 45 years of age and over had higher rates

for diseases of the digestive system. U.S. patients 65 years

of age and over also had a higher discharge rate for neoplasms.

The discharge rate, average length of stay, and rate of days

of care for symptoms, signs, and ill-defined conditions were

higher in France.

The main difference in hospital use by marital status

was the higher proportion of discharges and days of care

for the divcg-cedkeparated category in the United States. This

difference reflects the higher proportion of the U.S. population

that was divorced. In addition, the U.S. category was more

broadly defined, including all separations, whether or not

legally established.

The main difference in the disposition of patients was

that French patients were twice as likely as U,S. patients

to be reported as transfers. Again, the definitions of the category were not the same. The French category included transfers

from short-term to medium or long-term departments of the

same hospital, which were not counted in the United States.

Nevertheless, the difference may indicate a greater availability

of intermediate levels of care between acute treatment and

being discharged home in France. French patients 1544 years

of age and 45–64 years of age were more likely than U.S.

patients to be transfers, but the difference was not significant

for patients 65 years of age and over.

These definitional differences were one of the problems

that arose from comparison of data from surveys that were

designed and carried out independently. The survey methodologies, data collection procedures, questionnaires, and other

aspects of the U.S. National Hospital Discharge Survey and

the French survey of hospitalization were somewhat different.

However, the analysis of the data was closely coordinated

between the two countries. In addition, the small size of

the French survey precluded more detailed analysis of the

data and made it necessary for differences between the countries to be quite large before they would reach statistical

significance.

These problems could be addressed by the establishment

of coordinated cross-national studies. Such studies, using similar definitions and methodologies, would allow more precise

and detailed analysis of the functioning of hospitals, and the

health status of the populations, in countries with different

health care systems.

44
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/iott. Chicago.

Com-Ruclle, L. 1984. Enquete sur Ies Hospitalises: La Morbidite

Hospitaliere. No. 4885-631. Paris: Centre de Recherche pour L’Etude

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Com-Ruelle, L., L. Haeusler, A. Mizrahi, and A. Mizrahi. 1982.

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Com-Ruelle, L., L. Haeusler, and R. Zahariev. 1983. Enquete sur

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Douxami, D., S. Elbaz, S. Laloum, and A. M. Louers. 1982.

Statistique annuelle des &ablissements d’hospitalisation de soins ou

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Phy,~ician Characteristics and Distribution inthe U.S., 1982 Edition.

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Gascon, M. O., and D. Leroux. 1980. Statistiques de morbidite

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Gibson, R. M., and D. R. Waldo. 1982. National health expenditures,

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Gottely, P,, and E. Puichaud. 1983. Statistiques annuelledes&ablisscments d’hospitalisation pnw%. Sant4 S&curitZ Sociafe, Statistiques et Commentaires. (4):5-84.

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Causes Mkdicales de D&t?s, Annke 1981. Paris.

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La situation d6mographique en France en 1980. Les Collections

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Institute of Medicine. 1980. Report ofa Srudy, Reliability of National

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Lccomte, T,, A. Mizrahi, A. Mizrahi, and D. Pilliard. 1980. Enquete

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45
U.S. Bureau of the Census. 1981. Marital status and living arrangements, March 1981. Currenl Population Reporrs. Series P-20, No.

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U.S. Bureau of the Census. 1982. Preliminary estimates of the

population of the United States by age, sex, and race: 1970 to

1981. Current Popu/arion Repot-/s. Series P-25, No. 917.

Washington: U.S. Government Printing Office.

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1984. Geneva.

46
List of detailed tables

1.

2.

3.

4,

5.

6.

7.

8.

9.

10.

Il.

12.

13.

14,

15,

16.

17.

Population estimates by sex and age: United States

and France, 1981 . . . . . . . . . . . . . . . . . ...49

Percent distributions of population by age, according

to sex: United States and France, 1981 . . . . . . . . . 49

Percent distributions of population by sex, according

to age: United States and France, 1981 . . . . . . . . . 50

Percent distributions of population by marital status,

according to age: United States and France, 1981 . . . . 50

Rates of beds in hospitals and other health care facilities

by type of service and ownership United States and

France, 1981 . . . . . . . . . . . . . . . . . . . ...50

Percent distributions and rates of beds in all and shortstay hospital services by ownership: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . ...51

Percent distributions of all and short-stay hospital beds by

bed size of hospital: United States, 1981, and France,

1980 . . . . . . . . . . . . . . . . . . . . . . . . ..5 I

Death rates by age and sex: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . . ..5I

Death rates for leading causes of death, by sex:

United States and France, 1981 . . . . . . . . . . . . . 52

Death rates for leading causes of death, by sex, for

infants under 1 year of age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . ...52

Death rates for leading causes of death, by sex, for

children 1-14 years of age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . ...53

Death rates for leading causes of death, by sex, for

persons 15-44 years of age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . ...53

Death rates for leading causes of death, by sex, for

persons 45-64 years of age: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . ...54

Death rates for leading causes of death, by sex, for

persons 65 years and over: United States and France,

1981 . . . . . . . . . . . . . . . . . . . . . . . ...54

Rates and percent distributions of patients discharged

from short-stay hospitals or services by age, according to

sex: United States and France, 1981 . . . . . . . . . . . 55

Rates and percent distributions of days of care for

patients discharged from short-stay hospitals or services

by age, according to sex: United States and France,

1981 . . . . . . ...”..... . . . . . . . . . ...55

,Average lengths of stay for patients discharged from

short-stay hospitals or services, by age and sex: United

StatcsandFrancc, 1981 . . . . . . . . . . . . . . . . . 56

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

Rates of patients discharged from short-stay hospitals or

services by selected diagnostic category and sex: United

Statesand France, 1981 . . . . . . . . . . . . . . . . .

Percent distributions’ of patients discharged from shortstay hospitals or services by selected diagnostic category,

according to sex: United States and France, 1981 . . . .

Rates of days of care for patients discharged from shortstay hospitals or services, by selected diagnostic category

and sex: United States and France, 1981 . . . . . . . . .

Percent distributions of days of care for patients

discharged from short-stay hospitals or services by

selected diagnostic category, according to sex: United

StatesandFrance, 1981 . . . . . . . . . . . . . . . . .

Average lengths of stay for patients discharged from

short-stay hospitals or services, by selected diagnostic

category and sex: United States and France, 1981 . . . .

Rates of discharges and days of care, and average lengths

of stay for patients 1544 years of age discharged from

short-stay hospitals or services, by selected diagnostic

category: United States and France, 1981 . . . . . . . .

Rates ofdischarges anddays of care, and average lengths

of stay for patients 45-64 years of age discharged from

short-stay hospitals or services, by selected diagnostic

category: United States and France, 1981 . . . . . . . .

Rates of discharges and days of care, and, average lengths

of stay for patients 65 years of age and over discharged

from short-stay hospitals or services, by selected

diagnostic category :United States and France, 1981 . . .

Rates ofdischarges anddays ofcare for patients 15 years

of age and over discharged from short-stay hospitals or

services, by age and marital status: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . .

Percent distributions of discharges and days of care for

patients discharged from short-stay hospitals or services

by marital status, according to age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . .

Average lengths of stay for patients discharged from

short-stay hospitals or services, by age and marital status:

United States and France, 1981 . . . . . . . . . . . . .

Percent distributions and average lengths of stay for

patients discharged from short-stay hospitals or services

by disposition, according to age: United States and

France, 1981 . . . . . . . . . . . . . . . . . . . . . .

Percent distributions of discharges and days of care for

patients discharged from short-stay hospitals or services

by bed size of hospital, according to age of patienti

United States and France, 1981 . . . . . . . . . . . . .

56

57

58

59

60

60

61

61

62

62

62

63

63

47
31. Average lengths of stay for patients discharged from according to age of patient: United States and France,

short-stay hospitals or services, by age of patient and bed 1981 . . . . . . . . . . . . . . . . . . . . . . . ...64

size of hospital: United States and France, 1981 . . . . . 64 33. Percent distributions ofdischarges and average Iengthsof

32. Percent distributions of discharges and days of care, and stay for patients dkcharged from short-stay hospitals or

average Iengths of stay forpatients discharged from short- services by source of paymenti United States and France,

stay hospitals or services by ownership of hospital, 1981 . . . . . . . . . . . . . . . . . . . . . . . ...65
Tablal. Population estimatea byaexandag= United States and Frsnce, 1981

LhritedSfafes France

Age Both sexes Male Female Both sexes Male Female

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Underl year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-14yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-S4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

227,659

51,226

3,591

47,634

105,746

41,231

36,262

26,235

44,432

22,499

21,934

26,253

15,693

7,999

2,362

109,912

26,192

1,639

24,353

52,048

20,464

18,791

12,772

21,112

10,857

10,255

10,560

6,893

2,961

706

Number in thousands

117,747 53,966

25,034 11,489

1,752 ’796

23,282 10,693

53,699 23,327

20,745 8,506

19,491 8,579

13,463 6,242

23,320 11,633

11,641 6,370

11,679 5,2S3

15,693 7,517

9,000 4,127

5,037 2,710

1,656 660

26,435

5,878

406

5,470

11,936

4,333

4,376

3,229

5,693

3,186

2,506

2,927

1,779

983

166

27,530

5,611

388

5,223

11,389

4,173

4,203

3,013

5,941

3,164

2,756

4,580

2,34S

1,728

514

SOURCE% U.S. Bureau of the Census. 1982. Prekminaw estimates of thewpulation oftie United Slalesby age, sex, andraw: 1970to1981. CumsntP@u/afion Re@s. Series P-25, No.9l7.

Washington: US. Government Printing Officw Institut Natiinal da la Stafisfique et des .%udes kmnomiques. 19e2. f.a Situation D6mographique en France an 19s0. Les Ce//aefbrIs da L’/NSEE.

Serfe D, No. 90. Perk.

Table2. Percent distributionsofpopulation byage, sccordingtoserc United Ststessnd France, 1981

Both sexes Male Female

United United United

Age group States France States France States France

Percent distribution

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0

Underl year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6

l-14years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.9

l&24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.1

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.8

35-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.5

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.9

56-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.6

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0

75-S4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0

1.5

19.8

15.6

15.9

11.6

11.8

9.6

7.6

5.0

1.3

1.7

22.2

18.6

17.1

11.6

9.9

9.3

6.3

2.7

0.6

1.5

20.7

16.4

16.6

12.2

12.1

9.5

6.7

3.7

0.6

1.5 1.4

19.8 19.0

17.6 15.2

16.6 15.3

11.4 10.9

9.9 11.6

9.9 10.0

7.6 8.5

4.3 6.3

1.4 1.9

SOURCES: U.S. Bureau of the Census. 1982. Pretiminav estimates of thewpulation of the United States byage, sex, andrace 1970to1981. Cuwent Popu/afim Re@s. Series P-25, No.9l7.

Washington: U.8. Government Printing OfficW Institut National de la Statistique et des &udes kmomiques. 1982. La 6ituafion D6mogrephique en France en 1980. LesCo//esbrs de L’/NSEE.

SerieD, No. 90. Paris.

49
Teble3. Percent distributionsofpopufstiorr byse&aocotingto~ United Stetes and France, 1981

United States France

Age group Sdh sexes Male Female Both sexes Male Female

Percent distribution

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 48.3 51.7 100.0 49.0 51.0

Underl year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 51.2 48.8 100.0 51.2 48.8

l-14years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 51.1 48.9 100.0

lE-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51.2 48.8

100.0 49.7 50.3 100.0 50.9 49.1

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 49.1 50.9 100.0

3.%44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51.0 49.0

100.0 48.7 51.3 100.0

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51.7 48.3

100.0 48.3 51.7 100.0

55-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50.0 50.0

100.0 46.8 53.2 100.0

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

47.6 52.4

100.0 43.4 56.6

75-S4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0 43.1 56.9

100.0 37.0 63.0 100.0

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36.3 63.7

100.0 29.9 70.1 100.0 24.4 75.6

SOURCES: U.S. Bureau of the Census. 1982. Pretimina~ estimates oftie@pulation oftie Unhed States byage, sex, atiraa1970 to1981. CumentPWu/afbn Re~tis. Seriea P-25, No.9l7,

Waehingtor’rU.S. Government Ptinfing Office; Insfilut Nafiinal de la Statisfique et dea !%des kenomiques. 1982. Le Sfueffon 06mogrephiiue en France en 19a0. Les Co//ecfians de L7NSEE.

Seiie D, No. 80. Paris.

Table4. Percent distributions ofpopuletion bymatil status, -dmgtoege United Ststesand Frsnce, 1981

15 years and over 15-44 years 45-64 years 65 years and over

United United United United

Marital status States France States France States France States Frame

Percent distribution

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.2 60.6 51.0 54.5 77.1

Single . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

79<9 54.7 49.5

25.8 27.0 39.5 42.0 4.8

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3

8.7 5.2 8.7

9.1

fJvorced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.5 0.5 7.9 7.2 35.5 39.0

6.2 3.3 6.3 3.1

Separated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 ...

7.7 4.2 3.5 2.B

2.7 --- 2.6 -- 1.0 ---

SOURCE5 U.S. Bureau of the Census. 1981. Marital sktusand hvingarrangemanS, March 1981. CumentPWu/atbn Repfls. Sariea P-20, No. 372. Washington: U.S. Government Printing

Ofk& Inatitut National de la Stafis~que et dea kfudea konorniques. 1982. La Situatiin D&ncgraphique en France an 1980. LesCWecfions da L’/NSEE. Serie D, No. 90. Paris,

Table5. Rates of&dsin hospkals andother ksHhure faciWmsby~~ofsewbe atiownerstip: United States and France, 1981

United States’ France

Type of service Total Public Private Total Public Private

Beds per 10,000 population

Ailfacilitie8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124.6 28.0 96.6 177.0 119.0 58.0

Hospitalservices ...,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.4 23.2 36.2

Medicalandsurgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111.4 77.9 33.5

39.9 10.4 29.5

Obsletricsandgynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55.2 36.1 19.0

2.7 0.7 2.0

Psychiatric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.9 3.4 2.4

11.1 8.6 2.6 25.2

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21.9 3.4

0.2 0.1 0.0 2.0 0.7

Ofherlong-term . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.3

5.5 3.4 2.0

Long-term carefacifities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23.1 15.7 7.4

65.2 4.e

Sections* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60.4 65.5 41.1 24.5

22.8

Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22.8

65.2 4.8 60.4 42.7 18.3 24.5

lU.S, hospital beds not repafedbysetvice were clessitied acsordingto type of hospital. For example, bedain psychiatrichospitals not reported by type of service were muntedaa psychiatric

sewice beds. Nursing home data were for 1982.

‘Sections of hospital institutions.

SOURCES American HospitalAssociation. 1982. f-fospi@/S/afistics,lW2Edf;M. CMwgo(Copytight 1982:Us~with thepmission of the Amerkan HospitalAssmiatbn); National Center for

Health Statistics,A. Birrocca. 1985. Anovewiew of the1982National Maater Facih~lnvento~ Suweyof nursing andrelated care homes.A&an@ Dafa From Vifa/ati Hea/lh Sfatist&. No. 111

DHHSPub. No. (PHS)8S1250. PubEcHealth Sewim. HyaHsville,Md.; D. Douxami,S, Elbz, S. Lalaum, and A.M. Louers. 19e2. Statistiques annuelle des6tabtissements dhospitahsatinde

soinsoude cure publics, ann6e 1981. Sanfc+Sdcurit.4 SockVe, sfatistiques etcommentaires. (6):63-111, Nov.-DEc. P. Gottely and & Puichaud. 1983. Stafistiques annuelle dss6tabiissements

dhospitalisafion priv6s. Smrfd Wcuritd Sociah, sfatistiques et corrrmentaires. (4):5-84 Ministbredea Affairea Socialea et de la Solidarit6 Nationale. 1964.Arrruaire des Stafisfiques Sanifaires d

Socialas, 1982-19SS.Paris,

50
Tabfe 6. Fercent distributions and rates of beds in all and ahotWay hospital serviosssby ownerehifx United 8tates and France, 1881

All hospitals Shofl-stay services’

United United

ownership States France States France

Percent distribution

100.0 100.0 100.0 100.0

53.4 12.5 63.9

7.5 17.5 8.5

39.1 69.9 27.6

Rate per 10,000 population

59.4 111.4 48.4

31.7 13.9 30.9

4.5 19.6 4.1

23.2 77.9 13.4

11.2

24.0

64.6

61.0

6.8

14.6

39.6

‘Refers to beds In short-stay hospitals for the United Statea and to beda in short-stay hospital services for France.

SOURCE5 American HospitalAssociation. 1982. HoapitslStatistics,79S2.Edifiorr. Chwgo (Copyright 1982 Usad with the permissionof the American Hospital Asaociatiin); Ministbre rks

Aftalrea Saciales et de la 3oliiarit6 Nationale. 1982. .4rmuairedes Statist@uesSsrritsirsset Sosides, 79s2-19s3. Pan% P. Gottely and & Puichaud. 19S3. Statisfiiuea annuelle des

6tabllssements dhospitalisation priv~s. Sarrtc+ Sr$curit.4SocMe, stafistiqueset conmrerrtaires.(4):5-64.

Tabfe 7. Percent distributionsof all and short-stay hospital beds by bed size of hoapitsh United Sfateaj 1981, and France, 1980

All hospitals Short-stay services’

United Unitad

Ownership States France States France

Percent distribution

Allalzas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

Fewarthan 50 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 6.9 4.3 6.7

SO-119beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.6 20.0 14.6 19.6

120-399beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.6 23.4 44.9 25.5

400-799beda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.1 13.7 27.3 12.9

800-l,399beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.6 14.0 8.0 9.5

l,400bedsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 22.0 1.0 23.9

lRefera to bWsinshoR-stay hospitals fortie United Sktesadtob4s inshort-stay hospifal services for France.

SOURCES American Hospital Aaseciatkm. Unpublished data from the 1981 Annual Survey of hospitelw L. Com-Ruelle, L. Haeusler, A. Mizrahi, and A. Mizralri. 1982. Les Et8b/iasements

HoWifa//eraen f9&7. No. 4824/579. Paria. Cantre de Recharche Pour L’Etude et L’Obsewation des Condtins de Vie.

Table8, Death rates bysfgeandaex: United Stateaand Franoe,1981

Both sexes Male Female

United United United

Age group States France States France States France

Rate par 100,000 population

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 662.4 1,028.1 954.5 1,0ss.0 775.4 970.6

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,207.3 982.5 1,331.8 1,132.9 1,076.7 624.3

l-14yeiars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.0 37.5 44.6 42.9 31.2 31.7

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107.1 97.6 158.3 140.6 64.8 52.9

2%34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f32.1 114.0 190.6 156.9 74.3 67.2

3544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221.3 210.2 291.9 278.9 153.2 136.7

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573.5 545.6 751.7 782.7 406.9 308.2

55-S4years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,322.1 1,103.7 1,774.7 1,615.2 925.2 638.7

65-74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,922.3 2,652.5 3,994.6 3,852.0 2,100.6 1,743.9

76-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,429.9 6,SS7.2 S,519.6 9,123.5 5,201.0 5,615.3

85yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,379.7 18,059.2 18,13S.2 21,136.3 14,202.5 17,068.6

SOURCES Natbnal Center ror Healti Statistic. 19W. AdvanwreWR of final MtihWs@tistim, 19Sl. Mwth&Wfa/SYatistim Re@R. Vol.33, No.3, Suw. DHHSPub. No. (PHS)Wll~.

Public Health Sewim. Hyatisville, Md.; lnstitut Natbnal dela Sant6et dela R*erche MWnle. l%l. Causes ~#itiles*DWs, An~e f~j.paria.

51
T#Xs 9. Death rates for leading causes of &athj by aex United Statea and France, 1981

Seth sexes Male Female

United United United

Cause of death and ICD-9 Codeq States France States France States France

Allcauees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseaees of the circulatory system... . . . . . . . . . . . . . . . . . . . . . . . ...390-$59

Iachemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..41G414

Acute myccardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410

Cerebrovasculardisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Heartfailureand ill-detinedheartdisease . . . . . . . . . . . . . . . . . . . . . . . . 426-429

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantnaoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208

Malignant neoplasm oftrachea, bronchus, andlung . . . . . . . . . . . . . . . . . . . . 162

Malignant neoplasm ofintesfine, rectum, and anus. . . . . . . . . . . . . . . . . . 152-154

Injutyand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E800-E999

Accidents andadveree effects . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ESCO-E949

Traffic accidents . . . . . . . . . . . . . . . . . . . . . . . . . . .. E81O-E819. E828-E829

Oisaaees of the respiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Chronic obstructive pulmonary disease . . . . . . . . . . . . . . . . . . . . 490+92, 494,496

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...480-486

Oieeaees of thedigesfive system.. . . . . . . . . . . . . . . . . . . . . . . . . ...52&579

Alcoholic liver diseases and other cirrhosis of the liver . . . . . . . . . . . .571 .0-571.3, 571.5

Endocrine, nutritional and metabolic diseases, and immunity disorders. . . . . . . . . . 240-279

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Unknown and unspecified cause.... . . . . . . . . . . . . . . . . . . . . . . . . ...799.9

862.4

426.3

242.1

127.5

71.3

45.1

186.8

184.0

46.5

23.6

67.8

43.9

22.0

57.3

24.3

22.1

32.3

11.6

“20.0

12.9

8.2

Rate per 100,000 population

1,028.1

374.8

95.1

72.9

124.1

75.1

242.6

234.7

32.8

27.7

93.3

69.1

20.5

69.3

20.4

11.8

65.7

27.0

25.2

67.2

23.9

954.5

445.6

272.7

155.1

59.6

44.1

207.1

204.5

66.9

23.6

101.2

63.6

33.0

70.0

34.5

23.3

35.8

15.6

17.0

15.4

10.1

1,088.0

352.6

108.3

84.4

106.1

61.3

295.0

286.9

59.1

28.7

114.8

79.9

30.6

77.6

28.4

11.1

75.5

39.0

20.0

62.0

28.5

775.4

406.0

213.1

101.4

82.3

45.9

167.5

164.7

25.3

23.5

36.3

25.3

11.6

45.2

14.7

21.0

29.0

7.7

22.7

10.5

6.4

970.6

396.1

82.3

61.9

141.4

88.3

192.3

164.5

7.5

26.7

72.8

58.7

10.9

61.4

12.8

12.5

56.3

15.5

30.1

72.2

19.5

‘Manualof the InternationalStatisticalClassificationof D/saases,Injuriesand Causesof Death (based on resornmendafkmsof theNinthRevisionConference,1975).

SOURCESNatbnalCenterfor HealthStatistics.1984. Advancereporiof final mortafiiy statistics, 1981. Monthly Vital StatisticsReport.Vol.33, No.3, Supp. DHHSPub.No.(PHS)84-1120.

PublicHealthService.Hyaffsville,Md.; National Center for Health Statistics, Divfsion of Vial Statistics. Unpublished mortality datw lnstitut Nafiinal de la Sant4 et de la Racherche M6dicale.

Causes M4dicafas de DL$As, Anmts 19S1. Paris; World Health Organization. 19S4. Wodd Hearth Statktfcs Annual, 19S4. Geneva.

Tsbba10. Death rates for leading ceuaes of deathj by aex for infants under 1 year of age United Statea snd France, 1981

Seth sexes Male Female

United United United

Cause of death and ICD-9 code’ States France States France States France

Rate per 100,000 tive births

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1.193.2 971.2 1,314.4 1,118.1 1,065.8 816.3

Certain mndifions originating in the perinatal period . . . . . . . . . . . . . . . . . . . 76&779 592.7 251.5 657.3 289.7 524.7 211.2

Anoxia and other respiratory conditions . . . . . . . . . . . . . . . . . . . . . . . . . 766-770 257.1 124.9 298.0 147.5 214.2 101.0

Dieorders relating to short gestation and unspecified low birth weight . . . . . . . . . . . . 765 100.8 18.0 105.8 17.4 95.5 18.6

Sirth trauma and fetal and neonatal hemorrhage . . . . . . . . . . . . . . . . . . . . 767,772 50.3 22.1 55.0 25.2 45.4 18.9

Infections specific totheperinatal period . . . . . . . . . . . . . . . . . . . . . . . . ...771 24.7 36.4 26.6 40.9 22.7

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

31.6

245.6 216.9 256.4 248.4 234.3 163.7

Congenital anomaliea of circulatory system . . . . . . . . . . . . . . . . . . . . . . . 74%747 96.3 111.7 106.7 128.7 89.4 93.9

Congenital anomalies of nervous system . . . . . . . . . . . . . . . . . . . . . . . . 740-742 45.5 31.2 40.2 32.9 51.2 29.3

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . 780-799 164.1 305.s 191.0 351.8 135.7 257.4

Sudden death, cause unknown.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..79e 146.0 120.4 171.2 147.5 119.6 91.6

Unknown and unspecified cause.... . . . . . . . . . . . . . . . . . . . . . . . . ...799.9 15.3 173.7 17.0 169.9 13.4 156.6

Dieeaeesoftherespiratorys ystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519 41.7 20.7 4s.1 23.0 35.0 18.4

Injury andpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E800-E999 35.3 85.5 36.8 101.8 33.7 68.4

Accidents and adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E800-E949 27.0 S2.4 29.1 98.4 24.8 65.6

lManus/of the /ntematbrra/ Statistioa/ C/aasifioatbr of Diseases, /njuries and Causas of Desth (based on recommendationsof the Ninlh RevisionGanference, 1975).

SOURCES: National Center for Health Statistics. 1984. Advance report of final rnortalify statistics, 1981. Mmtfrfy Vital Statistics Report. Vol. 3S, No. 3, Supp. DHHS Pub. No. (PHS)S4-1120.

Pubfic Heailh Service. Hyatfsville,Md.; National Center for Health Statistics, Division of Vital Statistics, Unpublished martafitydata Institut National de la Sant.4et de la Recherche M&Jiale. 1961.

Causes M.4dicstes de D&&s, Ann@ 19S1. Paris.

52
Tsbfe 11. Death rates for feeding causes of deatm by sex, for chitdren 1-14 yeare of age United States snd France, 1981

Both sexes Male Female

United United United

Cause of death and ICD-9 code’ States France States France States France

Rste par 100,000 population

Allcauses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.0 37.5 44.6 42.9 31.2 31.7

Injuryandpolsoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . ..E6*E999 19.1 15.7 24.4 19.6 13.7 11.7

Accidertlssndadverseeffeck..... . . . . . . . . . . . . . . . . . . . . . . ..E800-E949 16.8 14.1 21.7 17.3 11.7 10.7

Trafficaccidents . . . . . . . . . . . .. - . . .. - . . . . . . . ..E81~E8191 E82S_E829 7.0 8.3 8.8 7.4 5.4 5.2

Homicide andinjury purposely inflicted byotherpersons. . . . . . . . . . . . . . .E960+969 1.6 0.4 1.8 0.4 1.5 0.3

Neoplasms . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 4.6 8.2 5.1 6.9 4.1 5.5

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208 4.3 5.3 4.8 5.9 3.8 4.7

Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -.204-208 1.7 2.5 2.0 2.8 1.4 2.1

Congenltalanomafies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74~759 3.3 3.2 3.3 3.3 3.2 3.0

Congenitalanomaliesofcircutatorysystem . . . . . . . . . . . . . . . . . . . . . . . 745-747 1.8 1.6 1.9 2.0 1.8 1.6

Dlseasesofthenewoussystemand sense organs . . . . . . . . . . . - . . . . . . . . 32=69 2.7 2.9 2.e 3.2 2.5 2.6

Dineasesoftherespiratorysystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-51g 1.9 1.6 2.0 1.7 1.7 1.4

Diseasesofthecirculatotysystem.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39D459 1.8 1.4 1.8 1.5 1.7 1.2

Symptoms, signs, andill-definedconcfitions . . . . . . . . . . . . . . . . . . . . . . . . 780-799 0.9 2.4 1.1 2.7 0.8 2.2

Unknownand unspecifiedcause. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...799.9 13.6 1.6 0.7 1.7 0.4 1.4

lMmrua/of the Mrnationa/ StatisficdC/assificaW of Diseases,Injuries and Causes of Oeath (baaed on recommendations of the Ninth Revision Conference, 1975).

80URCES Nstional Center for Health Stafiafica. 19S4.Advance report of final morfafityatatiatica,1981. Monthly Vifa/Statisticsr%port.Vol. 33, No. 3, Supp. DHHS Pub. No. (PHS) S4-1120.

Public Health Service. Hyafteville,Md.; National Center for Health Statistics, Oivision of vital Statistics. Unpubfiahad morfalily dab Insfilut National de la Sant6 et de la Recherche M6diile.

Causes A4f&afas ds D,4cds, Annda19S1. Paria; WorkJ Health Organizafh. 1984. Wodd Hesfth Statist& Annual, 1984. Geneva.

Tsbfe 12. Death rates for leading csusea of deathj by ae% for persona 15-44 yeare of age United States and Frsnce, 1981

Both sexes Male Female

United United United

Cause of death and ICD-9 wale’ States France States France States France

Allcauees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury andpoisonlng . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E80*E999

Arxldents andadveree effects . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E80rJ-E949

Trsfflc accidents . . . . . . . . . . . . . . . . . . . . . . . . . . .. E61~E619. E62GE829

Homicide andlnjury purposely inflicted byother persons . . . . . . . . . - . . . . . E960-869

Suicide andeelf-infticted injuw . . . . ..- . . . . . . . . . . . . . . . . . . . . .. E95~E959

Diseases of thecirculatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390-459

Ischemlo heart dleease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...41~14

Acute myocardlal infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .410

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .431J-438

Neop!asms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 14*239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140-208

Malignant neoplaem of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174-175

Diseases of thedlgestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Alcoholic liver disease andother cirrhosis of thehver. . . . . . . . . . . .571.0-571 .3,571.5

Symptoms, signe, andill-dsfined concfitions . . . . . . . . . . . . . . . . . . . . . . . . 78~799

Unknown and unspecified cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .799.9

Diseases of the respiratory system.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46~19

Diseases of thenenrous system andsenseorgans . . . . . . . . . . . . . . . . . . . . 320-389

t 44.2

79.5

47.0

31.1

15.6

14.6

19.1

8.2

5.5

3.4

19.1

18.8

2.8

6.4

3.6

3.4

3.0

3.4

2.9

Rate per 100,000 population

133.6 202.3 184.7 86.5

65.7 126.0 99.5 33.3

43.7 74.6 67.6 19.6

26.3 47.9 40.3 14.4

1.2 25.5 1.6 6.1

i 7.0 22.6 24.6 6.7

12.2 26.2 17.3 12.1

3.3 13.5 5.8 3.0

3.0 9.1 5.2 1.9

3.4 3.4 4.4 3.3

22.4 16.2 25.0 19.9

21.0 17.7 23.6 19.4

2.4 0.0 0.0 5.6

8.0 8.5 9.7 4.4

5.4 5.0 6.2 2.2

11.0 4.5 15.8 2.3

9.2 3.9 13.2 2.0

2.7 4.0 3.3 2.8

3.4 3.5 4.5 2.3

60.4

30.2

16.6

11.6

0.7

8.8

6.8

0.8

0.7

2.4

19.6

16.3

4.9

6.3

4.7

6.2

5.0

2.2

2.4

'Mnm/o/ tW/ntmftia/ Slafistti/ C/aSifimfhn of Diseases, /rrjuries and Causes of Oeath (baSSdon recommendafionsof fhe Ninfh Retision Conference, 1975).

SOURCE5 Natbnal Center for Health Statistim.1984. Atiawre~ti of final modah~statistim,1981 .Month& Wta/Statisti& R~fl. Vol. W, No.3, SuW. DHHSPub. No. (PHS)%ll2O.

Public Herdth Service. Hyaffsville, Md; Nat”wal Center for Health Statisfii, Dwision of Vital Statistics. Unpublished nwtafity datz Institut National de la Sant6 et de la Recherche M6dicaIe.

Cames Wtiksde ~s, Ann& l~f. Padx WorMHeaMh Orgmizafon. l9~. Wodd Hea/th Statistics Anrrue/, f9S4. Geneva.

53
Lbth sexes Mafa Female

United United United

Cause of deathand ICD-9 code’ States France States France Statas France

Rate per 100,000 population

Allcauaas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oiseaeeaof thecirculatory system... . . . . . . . . . . . . . . . . . . . . . . . ...390-459

Ischemic heart diaesee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 410+$14

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410

Cerebrovaeculardisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4s0-436

Heartfailureandill-definedheartdiseaea . . . . . . . . . . . . . . . . . . . . . . . . 426-42g

Neoplasms . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . ...14&239

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140_208

Malignantneoplasmoftrachaa,bronchus, and lung . . . . . . . . . . . . . . . . . . . . 162

Malignantneoplasmofbreast... . . . . . . . . . . . . . . . . . . . . . . . ...174-175

Malignant neoplasm ofintestine, ractum, andanua. . . . . . . . . . . . . . . . . . 152-154

Malignant neoplasm ofiip, oral cavity, and pharynx . . . . . . . . . . . . . . . . . 140-149

Injury andpoieoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E8fXf_Eggg

Accidents and adverse effects . . . . . . . . . . . . . . . . . . . . . . . . . . . .. EmtJ-Eg4g

Suicide andself-inflicted injury . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E950-E953

Diseaees of thedigestive system... . . . . . . . . . . . . . . . . . . . . . . . . ..520+7g

Alcoholic liver dieeaee andother cirrhosis of the fiver. . . . . . . . . . . . .571.0.-571 .3,571.5

Oieeaeesof the respiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Chronic obstructive pulmonary dieeaees. . . . . . . . . . . . . . . . . . . . 490+92,494,496

Symptoms, signs, andilldetined condtions . . . . , . . . . . . . . . . . . . . . . . . . 780-7gg

Unknown andunspecifiad cause.... . . . . . . . . . . . . . . . . . . . . . . . . ...799.9

942.8

367.8

242.6

156.9

43.8

32.0

308.0

304.7

86.3

33.6

30.0

8.3

66.4

39.0

16.2

54.2

31.1

46.8

24.3

12.5

10.6

798.1

177.6

71.2

58.5

44.6

19.0

315.7

306.5

56.0

27.0

23.3

28.5

66.1

51.9

28.7

66.7

64.2

30.1

9.8

34.6

22.9

1,247.6

566.1

379.6

250.0

46.4

47.4

351.2

347.6

142.4

0.4

33.8

12.5

101.3

59.5

23.7

71.9

43.9

62.8

33.2

17.6

15.2

1,149.2

271.0

121.9

100.9

59.5

27.7

434.6

423.7

104.4

0.8

26.1

54.3

129.3

79.6

42.0

126.7

92.5

46.6

16.5

52.1

34.7

666.5

225.9

118.5

76.3

39.3

16.1

266.9

265.8

54.6

63.6

26.5

4.4

34.6

20.4

9.4

36.1

19.5

32.3

16.2

7.6

6.5

481.6

66.0

21.7

17.9

30.4

10.7

201.6

164.2

9.6

52.2

16.8

3.9

44.6

25.4

16.0

52.3

37.1

12.3

3.4

17.6

11.5

'Marrual of fhekrtamatiorra/ Slar/stica/ C/aaaificstbn of Diamsea, /~”udas arrd Causes of Daa.th(beeadon racemrnendafionaof theNinthRevisicaCcmferenca,1975).

SOURCESNalbnalCenterfor HsallhStatistic. lW. Atiamere~ti offinalmtiafi&tiatiatim, lWl. Wth/y Wta/Shfkt& H~. Vol.W, No.3, S~p. DHHSPub.No.(PHS)Wllm,

PublicHsalth3ervica. Hyattsville,Md.:NatkaialCenterforHealthStatistics,DivisionofVial Statiatii. Unpublishedmortalitydata institufNationaldala Sent4etde fa RacherchsIMkliila.

CauaeaMddioafasde D&b, Annda 1981. Park WorldHealthOrganization.1934. WorldHeafth Statistics Annual, 19S4. Geneva.

‘RIM 14. Death ratea for feading causes of death by sex for parsons 66 years and OVSK United States and France, 1981

Both sexes Mafa Femata

United United Unitad

Cause of deathand ICD-9 ode’ States France States France Stataa Franm

Rate per 100,000 population

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseaees ofthacirculatory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 390-459

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...41&414

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4Io

Cerebrovascular dkease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4s0+86

Heart failure and ill-defined heart disease . . . . . . . . . . . . . . . . . . . . . . . . 426-42g

Naoplasme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Ma~gnant neoplaems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-20s

Mafignant neoplasm of trachea, bronchue, and lung . . . . . . . . . . . . . . . . . . . . 162

Malignant naoplaem of intestine, rectum, and anus . . . . . . . . . . . . . . . . . . IW-I!M

Oieeases of therespiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 450-519

Chronic obstructive pulmonary diseases. . . . . . . . . . . . . . . . . . . . 490-492,494,495

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..43~6

Diseaees of thedigestive system... . . . . . . . . . . . . . . . . . . . . . . . ...520-579

Endocrine, nutritional and metabolic diaeaaas, and immunity disofdars. . . . . . . . . . 240-279

Injury and fwiaoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E6f)(f_Eggg

Accidente andadveree effacta . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E300+949

. Accidental falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. E860-Ew

Symptoms, eigns, andill-definad conditions . . . . . . . . . . . . . . . . . . . . . . . . 780-7gg

Senility without mention of psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7g7

5,108.5

2,980.9

1,666.8

822.0

533.9

332.7

1,022.4

1,007.1

232.5

149.9

397.6

169.3

161.2

161.0

123.7

114.3

90.4

34.3

52.5

4.0

5,573.1

2,374.7

562.6

423.4

810.5

504.6

1,173.7

1,136.9

142.5

159.2

438.3

129.9

76.9

308.1

154.7

301.4

251.1

144.5

356.6

143.9

6,207.5

3,424.2

2,047.4

1,089.4

513.2

359.0

1,376.7

1,359.7

425.4

174.1

579.1

294.8

195.3

186.4

116.1

162.0

117.6

35.8

67.4

3.2

6,599.6

2,562.2

717.7

544.5

823.3

490.6

1,701.4

1,659.1

316.6

200.0

586.7

222.2

65.3

393.9

140.3

328.8

244.6

104.5

340.9

96.3

4,370.1

2,682.4

1,413.8

641.9

547.6

315.0

763.6

786.6

102.6

133.5

275.4

64.8

136.2

143.9

128.9

52.2

72.1

33.3

42.5

4.6

4,918.5

2,242.3

463.7

346.2

602.4

513.4

637.2

804.0

31.5

133.1

343.7

71.0

71.6

263.3

164.0

283.9

255.3

170.0

389.6

174.3

lManua/ ofthalrrtemstii-me/ Statisf&# Classifiirjon of D&esee, /njwiasatmjCauaasof Dsa.th(b ee.edon remmtitisof WMnth RevMonConferenca,1975).

SOURCES NationalCenterfor HealthStetistke.19S4.Advancereportoffinalmertalitystatistics,1S31.Monfhfy Wta/ StaYiatb Report. Vol. &3, No.3, Supp.DHHSPub.No. (PHS) 64-1120.

PubIii Heaith6ervice. Hyaftevill.s,M&; Natial Canterfor Hem Sfetiefh, Djjs&M of MfSISfem. lJnpuW~ MOIWWdew j~~~ Na~~ da Ia ~t~ et ~ la R~~ ~.

Causes M4dicalaa da D&4s, Annda 1SS1. Pari%WorldHeallhChgsnization.19S4. WoIMHearthStatisticsAmwaf, 19S4.Geneva.

54
TeMs 15. Rstas and percent distrihtiona of ps6ants disoherged fmn short-stsy hos@sfs or services by sgq accordng to sex United States and

Frsnoe, 1961

Both sexes Mak Femak

United United

Age

united

States Frarroa states Franoe States Frsrrca

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-14yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26-34yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36-44yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All agas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under lyear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-14yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3!H4yeaffi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

56-64yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

66-74yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

164.3

247.7

55.8

131.5

160.2

134.3

173.6

210.2

325.3

467.9

576.9

100.0

2.4

7.1

14.5

16.4

9.4

10.4

12.3

13.6

10.0

3.6

134.1

126.5

65.4

123.0

146.8

113.9

106.3

164.6

210.9

273.0

279.9

100.0

1.4

9.8

14.5

17.8

9.9

9.6

12.1

12.1

10.3

2.7

Rate per 1,000 population

136.2 123.4

273.2 .

61.0 80.1

72.0 97.7

87.3 79.7

110.4 108.2

163.4 125.6

219.6 166.7

357.2 253.9

510.5 280.7

649.7 .

Percent distribution

100.0 100.0

3.4 ●

9.9 13.5

9.8 13.1

11.0 10.7

9.4 10.7

11.8 12.4

15.0 13.0

16.4 13.9

10.1 8.5

3.1 ●

180.6

221.0

60.3

180.2

230.5

157.0

183.1

201.6

301.0

442.9

645.8

100.0

1.7

5.2

17.6

20.0

9.4

9.5

10.5

12.1

9.9

4.0

144.4

●

50.1

149.3

216.7

119.9

91.1

162.6

178.4

26s.7

251.6

100.0

●

6.6

15.8

23.1

9.2

7.3

11.3

10.7

11.8

3.3

NOTE Dataamforshofi-stay n~-FWemlhos@@ls inthe Unit% Slatmmdfor shoti-stay hmpfial setiesin Fr-e. NeWminfakaM paWn&admiRed mdd@w@onti_tiW

arsexclucbd.

Both sexes Male Female

United Unr?ad United

Age States France States France States Fransa

Rate per 1,000 population

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Underl year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-14yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

66-74yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

76-64yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alleges, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Underl year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-14yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-24yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26-34yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36-44yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46-54yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-64years . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75-64yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,212.6

1,701.9

230.3

615.8

842.2

880.6

1,319.9

1,607.0

3,254.6

6,116.7

6,901.7

100.0

2.2

4.0

9.2

11.7

8.4

10.8

14.4

18.7

14.8

5.9

1,501.9

1,464.9

497.0

648.7

1,101.0

1,059.3

1,072.2

2,189.2

3,732.9

4,722.9

6,017.9

100.0

1.4

6.6

9.0

11.7

8.2

8.5

14.3

19.2

15.9

5.1

1,066.0 1,419.1

1,638.8 ●

251.3 608.6

449.4 663.9

562.9 637.6

764.1 1,114.5

1,242.3 1,281.1

1,819.1 2,317.1

3,569.3 4,468.6

5,507.5 4,856.1

7,493.6 ●

Percent distribution

100.0 100.0

2.9 ●

5.2 8.9

7.8 7.9

9.0 7.4

6.3 9.6

11.5 10.9

15.9 15.5

21.0 21.2

13.9 12.7

4.5 ●

1,348.0

1,580.3

208.4

780.1

1,111.5

991.2

1,392.3

1,796.3

3,013.6

4,887.9

6,649.3

100.0

1.7

3.1

10.2

13.7

8.4

10.2

13.2

17.1

15.5

6.9

1,574.0

●

375.8

1,030.2

1,561.9

1,019.1

865.3

2,061.3

3,157.7

4,621.6

5,937.8

100.0

●

4.5

9.9

15.3

7.1

6.3

13.2

17.1

16.4

7.0

NOTE Dataare forehofl-stay non-Faderal hoapitala inthe United S~teaand forshoti.stay hospital sewkesin Frence. Newbminfmts andpatIenta admitid anddscharg@ ontiesamdate

are excludad.

55
Tabfe 17. Average lengths of stay for Patients discharged from shorMaY hoepitafa or services, by age and sex United States and France, 19S1

Both sexes Male Fanra&

United United United

Age States France states France States France

Average length of stay in daya

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 11.2 7.8 11.5 7.1 10.9

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 11.4 6.7 ●

7.1 ●

l-14years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 7.6 4.1 7.6 4.1 7.5

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 6.9 6.2 7.0 4.1 6.9

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 7.5 6.4 8.0 4.6 7.3

35-44yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.6 9.3 6.9 10.3 6.3 6.5

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 9.9 7.6 10.2 7.6 9.4

55-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 13.3 6.3 13.9 6.9 12.6

66-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.0 17.7 10.0 17.6 10.0 17.7

75-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9 17.3 10.8 17.3 11.0 17.2

65yearaandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.0 21.5 11.5 ●

12.2 23.6

NOTE Dataarefor short-staynon-Federalhosplalsin the UnitedStateaandfor short-stayhospitalservicesin France.Newborninfantsandpatientsadmitted and dischsvgad on the same date

ere excluded.

Table 18. Rates of patienta discharged from short-stay hospitals or services by selected diagnoetii categoty and sex: United States and Fmnce, 1981

Seth sexes Male Female

United United United

Diagnostic category and ICD-9 code’ Statas France States France States France

Allcondifionsz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infecfiousand paraaiticdiseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139

Neoplasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...14&239

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140-206,230-234

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210-229,236-239

Endocrine, nutritional and metabofic diseases, and immunity disorders. . . . . . . . . . 240-279

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseaaesofthenervoussystemand sense organs . . . . . . . . . . . . . . . . . . . . 320-389

Diseasesofthecentralnervoussystem . . . . . . . . . . . . . . . . . . . . 32D-336,34G349

Diseasesofthecirculatorysystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390-459

Heartdisease . . . . . . . . . . . . . . . . .391 -392.0,393-396,402, 404,410-416, 420+29

Cerebrovasculardisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Oiseasesoftherespiratorysystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diseasesofthectigestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Acuteappendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-543

Oiseaseaofthegenitourinarysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . 580-629

Complications of pregnancy, childbirth, and the puerperium . . . . . . . . . . . . . . . 630-676

Defiverieswithoutcomplications.. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...650

Oiseaseaoftheskinand subcutaneoustlasue . . . . . . . . . . . . . . . . . . . . . . 660-709

Diseases of the musculoakeletal system and connective fiasue . . . . . . . . . . . . . . 710-739

Arthropathiesandrelateddisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 714-719

Congenitalanomaties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74G759

Symptoms, signs, andill-definedconditions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-629

Supplementaryclassification... . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VOI-V82

164.3

2.9

11.1

8.6

2.5

5.0

7.5

7.8

1.9

23.0

14.4

3.5

15.0

20.3

1.2

14.8

20.6

7.9

2.5

10.0

2.3

1.4

2.7

15.2

4.9

2.4

134.1

3.3

11.1

6.2

2.9

5.1

6.4

6.6

2.5

12.2

3.2

1.9

6.8

13.5

3.6

8.4

14.6

6.1

2.4

7.0

2.5

3.8

6.4

16.0

5.8

3.2

Rate per 1,000 population

136.2

2.8

9.4

8.1

1.3

3.7

8.2

7.0

1.8

23.9

15.8

3.3

15.4

19.4

1.5

9.6

...

...

2.5

8.9

2.0

1.6

2.6

17.7

5.1

1.4

123.4

4.1

12.1

9.6

*

●

5.0

7.1

●

13.2

3.8

●

8.6

1.4.1

3.4

6.9

...

...

●

7.1

●

4.5

7.0

21.0

6.6

1.6

190.8

3.0

12.6

9.1

3.6

6.3

6.8

6.5

2.0

22.2

13.1

3.7

14.7

21.1

0.9

19.6

39.8

15.3

2.5

11.0

2.6

1.3

2.8

12.9

4.7

3.3

744.4

2.8

10.2

7.0

●

7.0

7.7

6.4

●

11.3

●

.

5.2

13.4

3.6

10.3

28,9

15.8

●

7.1

.

●

5.9

11.6

5.0

4.9

1Manu8/ of W? /rtfernatbna/Stafisf,WC/aasiflcatk?rr of Disesses, Irrjurfes mrd Causes of r2aath (based on recommendationsof theNinthRevisionConference,1e75).

‘Includesdiagnosticomditionsnotshownin table.

NOTE Dataareror short-stay non-Federal hospitals in the United States and for short-stay hospital services in France. Newborn infants and patients admitted and discharged on the same date

are excluded.

56
Tsbb 19. Psrosnt dbtributiins of patients discharged from short-stay hospiWa or services by selected dlsgnostiocategoty, aooordingto sex

Unftsd Ststss snd Frame, 1981

Seth sexes Male Female

United United United

Diagnostic catagofy and ICB9 codeq States France States France States Fransa

Percent distribution

Allconditlons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasltic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208. 230-234

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210-229,236-239

Endocrine, nutritional andmetabtic diseases, andimmuni~dsordem. . . . . . . . . . 240-279

Mental disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseases of the nervous system and sense organs . . . . . . . . . . . . . . . . . . . . 320-389

Diseases of the central nervous system . . . . . . . . . . . . . . . . . . . . 320-336,340-349

Diseases of the circulatory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 39H5g

Heart disease . . . . . . . . . . . . . . . . .391 -392.0,393-398,402, 404,410-416,420-429

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-436

Diseases of the respiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diseases of thedigestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Acute appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .540-543

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . 580-829

Complications of pregnancy, childbirth, and the puerperium . . . . . . . . . . . . . . . 630-676

Deliveries without complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...650

Diseases of the skin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . 66O-7O9

Diseases of the musculoskeletal system and connective tissue . . . . . . . . . . . . . . 710-739

Arthropathies and related disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 714-719

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..74G759

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . 760-799

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

Fractures, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .800-629

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

Other conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lM#nua/ of fW/ntemafbna/ Sfatisfka/ C/asificafbn of Diseases, /njuries and Causasof Death (besadon r.scornmemlatjonsofthe Ninfh RevisionCcmference,1975).

NOTE: Dataare forshoti-slay non-F@eral hospitals inthe Unitd Sktesand forskfi-atay ks@klsew"~s in FraM. Newkminfanta mdpatienk admtiAatid*ar@ Mtiamdab

are excluded.

100.0

1.8

6.7

5.2

1.5

3.1

4.5

4.7

1.1

14.0

6.8

2.1

9.1

12.3

0.7

9.0

12.5

4.8

1.5

6.1

1.4

0.9

1.7

9.2

3.0

?.5

1.3

100.0

2.5

6.3

6.2

2.2

3.8

4.8

5.0

1.9

9.2

2.4

1.4

5.1

10.2

2.7

6.3

11.0

6.1

1.8

5.3

1.8

2.6

4.8

12.1

4.3

2.5

4.5

100.0

1.9

6.9

5.9

1.0

2.7

6.0

5.1

1.3

17.5

11.6

2.4

11.3

14.2

1.1

7.1

...

...

1.8

6.5

1.4

1.2

1.9

13.0

3.7

1.1

1.6

100.0

3.3

9.9

7.9

.

,

4.1

5.8

.

10.7

3.1

.

7.0

11.5

2.8

5.6

...

...

.

5.7

.

3.7

5.7

17.1

5.4

1.3

4.1

I00.0

1.6

6.6

4.8

1.9

3.3

3.6

4.5

1.0

11.7

6.9

1.9

7.7

11.1

0.5

10.3

20.9

8.0

1.3

5.8

1.3

0.7

1.5

6.8

2.5

1.8

0.8

100.0

1.8

7.0

4.8

●

4.9

5.3

4.4

●

7.6

●

.

3.6

9.2

2.6

7.1

19.9

10.9

.

5.0

.

●

4.1

6.0

3.4

3.5

4.6

57
Tsble 20. Mmtiays dmmforptints tisckr@ hshti-shy ksmlsor se*% bysel@td &mosti Mtwwsnd sex Unftsd Ststesmd

France, 1981

Seth sexes Ma/a Female

United United United

Diagnostic category and ICL3-9 code’ States France States France States France

Rate per 1,000 population

Allconditions 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1.212.8

Infecfiousandparasificdiseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantnaoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-208.230-234

Benign naoplasms and neoplasms of uncertain behavior and unspecified

natUre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210-229,235-239

End~rine, nutritional andmetahhc dseases, andimmuni~ disorders. . . . . . . . . . 240-279

Mentaldieorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$.290-319

Diaeasesofthenervoussyatemand sense organs . . . . . . . . . . . . . . . . . . . . 320-389

Oiseasesofthecentral nervous system . . . . . . . . . . . . . . . . . . . . 320-336,34M4g

Oiseasesofthecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390459

Heartdisease . . . . . . . . . . . . . . . . .39 I-392. 0,393-398,402,404,41 O4I6,42O-429

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430-438

Diseases of therespiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diaeases of thedigeslivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-57g

Acute appandicifis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-543

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . 580-629

Complications ofpregnancy, childbirth, andthepuerperium . . . . . . . . . . . . , . . ~0+76

Deliveries withoul complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..65o

Oiseases of theskin andsubcutaneous fiasue . . . . . . . . . . . . . . . . . . . . . . 680_709

Dwasesof themusculoskeletal system and connective tissue. . . . . . . . . . . . . . 710-73g

Arthropathies andrelated cfisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 714-719

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 740-759

Symptoms, aigns, andill-defined conrjitions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-329

Supplementa~ classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VOl-V82

20.5

116.6

100.8

15.8

46.1

91.6

43.1

20.2

225.8

135.6

43.9

98.3

144.0

6.9

85.4

73.9

23.4

20.1

79.5

20.0

8.7

12.0

118.1

53.0

9.3

1,501.9

52.8

153.2

126.3

26.7

59.2

87.0

70.6

33.0

197.6

59.2

35.4

100.6

132.3

32.8

91.6

111.0

67.2

30.0

91.7

41.7

24.7

65.9

146.8

78.9

14.7

1,06s.0

19.9

105.9

97.8

8.0

33.5

97.7

39.7

19.7

225.1

141.8

39.8

103.0

127.9

8.7

62.6

...

...

18.9

65.7

15.0

10.0

11.2

121.9

45.7

6.3

1,419.1

66.1

176.7

147.8

●

●

41.0

66.2

.

217.8

74.1

●

133.3

142.4

33.0

79.3

...

...

.

81.6

●

28.3

57.4

199.5

103.6

8.6

1,348.0

21.1

126.7

103.6

23.1

57.8

85.8

46.3

20.7

228.4

129.8

47.8

93.8

159.1

5.3

106.8

142.9

45.3

21.2

92.4

24.8

7.6

12.8

114.6

59.7

12.1

1,574.0

39.5

130.6

107.8

.

60.5

130,9

76.2

●

180.8

.

●

71.8

131.3

32.3

106.1

219.6

131.1

●

102.9

●

●

73.7

103.2

55.5

20.1

lManua/oftb /nfematbna/ Sfalistba/ C/asaificationof Diseases, /njuries ati Causes of Oeath(bassd onremmmeMationa of the Nnth Revision Conference, 1975).

‘Includes diagnostic condtions not shown in table.

NOTE Da~areforshoti-stay nm-Ftieral hos@tals inthe United States and forshon-stay hospital sewices in FraNe. New@minfants andpatients admifled anddwharged mtheeame dale

are excluded.
T-21. Wmnttit~s of&ysof mreti Xk*ti@ti sM-*y~m *X byti4~nmti @m, mrtingto

eex: United States and France, 1SS1

Seth sexes Mafa Female

United United United

Diagnostic category and ICD-9 code’ States France States France Statea France

Percent distribution

Alloonditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious andparasific diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -....140-239

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-208.230-234

Banlgn neoplasma and neoplasms of uncertain behavior and unspecified

nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...210-229.235-239

Endocrine, nutritional and metabolic diseases, and immunify disorders. . . . . . . . . . 240-279

Menlaldlsorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseases of thenervous system andaense organs . . . . . . . . . . . . . . . . . . . . 320-389

Diseasea of thecentral nawous system . . . . . . . . . . . . . . . . . . . . 320-336,340-349

Diseases of theclrculatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390-459

Heart disease . . . . . . . . . . . . . . . . . 391-392.0,393-396,402, 404, 410-416,420429

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Diseaees oflheraspiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diseaaes of thedlgestlvesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Aculeappendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..54tJ-543

Diseases of thegenitourina~ aystem . . . . . . . . . . . . . . . . . . . . . . . . . . . 580-629

Complications ofpragnancy, childbirth, andthepuerperium . . . . . . . . . . . . . . . 630-676

Deliveries without compficationa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...650

Diseaaes of theskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . 630-709

Diceases of themusculoskelatal aystemand connective tissue. . . . . . . . . . . . . . 710-739

Arfhropathiea and related disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 714-719

Ccmganital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Symptoms, aigns, andill-detined conditions . . . . . . . . . . . . . . . . . . . . . . . . 760-799

Injury andpoisonkrg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- 800-999

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

Other conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

1.7

9.6

6.3

1.3

3.6

7.6

3.6

1.7

16.6

11.2

3.6

6.1

11.9

0.6

7.0

6.1

1.9

1.7

6.6

1.7

0.7

1.0

9.7

4.4

0.6

1.5

100.0

3.6

10.3

6.6

1.6

3.9

5.6

4.6

2.2

13.4

4.0

2.3

6.6

9.0

2.2

6.2

7.5

4.5

2.0

6.2

2.7

1.6

4.4

10.1

5.2

1.0

3.4

100.0

1.9

9.9

9.2

0.8

3.1

9.2

3.7

1.6

21.1

13.3

3.7

9.6

12.0

0.8

5.9

...

...

1.8

6.1

1.4

0.9

1.0

11.4

4.3

0.6

1.6

100.0

4.8

12.6

10.6

●

.

2.9

4.6

●

15.4

5.3

●

9.4

10.1

2.4

5.6

...

...

.

5.7

.

2.0

4.1

14.1

7.4

0.6

--

1.6

9.4

7.7

1.7

4.3

6.4

3.4

1.5

16.8

9.6

35

7.0

11.8

0.4

7.9

10.6

3.4

1.8

6.9

1.6

0.6

1.0

6.5

4.4

0.9

1.3

100.0

2.5

6.2

6.8

.

5.2

8.3

4.6

●

11.4

.

●

4.6

8.3

2.0

6.6

13.9

6.3

●

6.7

●

●

4.7

6.5

3.5

1.3

.-

lMwlofti lntmttial Statistic C/asfimttin of Dmses, lnjuties ati@uses of&ath(ksd mr-mmendatins oftie Mnti Retisrnn tinferem, l975).

NOTE Dataamforshoti-stay nM-FWsrsl hos@&ls inthe Uniled SMtes~forskti-sby kspital sewtisin Fram. Newbminfan& WpatienW admtidati d*hargd mthesamedate

are excludsd.

59
T- 22. Average lengths of stay for pstiertts discharged from sfwt-stsy Wspit#s or servicesj by selected diegnosfiocstqory and sex United States

and Frsnce, 1981

Sofhsexes Male Femala

united United United

Diagnosticcategoryand ICD-9 code’ States Frar& States Francw states France

Average length of stay in daya

Allconditions 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infacfious and parasitic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-139

Neoplasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantneopleems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140-208,230-234

Benign neoplasms and neoplasms of uncertain behavior and unspecified

nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210-229,23~239

Endatine, nutritional andmetabolic dseases, andimmuni~ dsorders. . . . . . . . . . 240-279

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseasesofthenervoussystemandsense organs . . . . . . . . . . . . . . . . . . . . 320-389

Diseasesofthecentral nervoussystem . . . . . . . . . . . . . . . . . . . . 320-338,340-349

Diseasesofthecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390459

Hearfdisease . . . . . . . . . . . . . . . . . 391-392.0,393-398,402, 404,410416, 420+29

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Diseases of the respiratory system... . . . . . . . . . . . . . . . . . . . . . . . . . . 450-519

Diseases of thedigestivesysfem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Acute appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..540-543

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . 580-629

Complications ofpregnancy, childbirth, andthepuerperium . . . . . . . . . . . . . . . 630-676

Deliveries without complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...650

Diseases of the skin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . 660-709

Diseases of the musculoskeletal system and connective tissue . . . . . . . . . . . . . . 710-739

Arthropathies and related disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 714-719

Cortgenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Injury andpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 800-999

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..80C+629

~upplementaryclassification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V01-V82

7.4

7.1

10.5

11.7

6.4

9.1

12.3

5.5

10.9

9.8

9.4

12.6

6.6

7.1

5.7

5.6

3.6

3.0

8.1

8.0

6.8

6.1

4.4

7.8

10.9

3.a

11.2

16.0

13.6

15.4

9.2

11.6

13.6

10.7

13.2

16.2

18.5

16.6

14.8

9.8

9.1

t 0.9

7.6

6.3

12.5

13.1

16.7

6.5

10.3

9.3

13.6

4.4

7.8

7.1

11.3

12.1

6.0

9.0

12.0

5.7

11.1

9.4

9.0

12.1

6.7

6.6

5.8

6.5

...

...

7.7

7.4

7.6

6.3

4.2

6.9

9.0

4.4

11.5

16.6

14.6

15.4

●

●

8.2

9.6

●

16.5

19.5

●

15.5

10.1

9.7

11.5

...

...

●

11.5

●

6.3

8.2

9.5

15.7

5.4

7.1

7,1

10.0

11.4

6.5

9.3

12.7

5.5

10.6

10.2

9.9

13.1

6.4

7.5

5.6

5.4

3.6

3.0

6.4

8.4

9.7

5.8

4.5

8.9

12.7

3.6

10.9

15.2

12.6

15.4

●

11.5

17.0

11.9

●

16.0

.

●

13.8

9.8

8.5

10.5

7.6

8.3

●

14.5

.

●

12,5

8.9

11.1

4.1

*Manua/oftha /ntarrratbrra/ StatistrW C/asaificstbn of D&sses, lnjutis ati Causesof&th(b%d onrsmmmetiafons of WMnti Rwisimtifemme, 1975).

‘Includesdiagnosticconditionsnotshown in table.

NOTE Da@areforshoti-stay non-Federal hospi@lsintie Unit~8tates atiforshd-stay kspftal aewiwsin Frana. Ne~minfank d~tienk Wmititimd dWa@ontb-daM

are excluded.

Tsble 23. MMoftiwhws sndtiys ofmm, andavem k@sofshyfir @kntslH yemd~~titiqmw

servicq by select6d d~nostic category: United States and France, 1981

Average length

Discharges Days of care of stay

United United United

Diagnosticcategoiyand ICD-9 code’ States France States Francw States Frarrsw

Allconditione z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasm. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

End~flne, nutritional andmetahfic deeases, andimmuni~ dsordeffi. . . . . . . . . . 240-279

Mental disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-819

Dieaases of therespiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diseases of thedigestivesyatem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Acute apperrdicifis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..5@-S48

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . 560-629

Complications ofpregrtancy, childbirth, andthepuerperium . . . . . . . . . . . . . . . 630-676

Aborfion andpregrtancy with aboriiveoutmme . . . . . . . . . . . . . . . . . . . . . 630-639

Deliveries without complication8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 650

Msea*sof themuxuloskeletal system andconnective tissue. . . . . . . . . . . . . . 710-739

Symptoms, signs, andilldefined conditions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Injury andpoieoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 600-999

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-629

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VOI-V82

Rate oar 1,000 copulation

f42.6

4.5

2.7

9.0

7.1

14.4

1.6

15.9

44.1

3.8

17.0

8.8

2.5

15.9

3.6

3.5

128.9

4.7

4.2

6.1

4.5

11.9

5.0

9.4

33.8

5.6

18.7

6.7

4.1

19.0

5.4

5.6

763.4

33.3

16.1

107.9

30.7

60.2

8.3

75.0

158.2

9.4

50.2

53.1

9.2

98.1

30.7

11.1

1,005.4

46.5

41.6

39.6

46.6

65.7

●

77.1

256.9

15.2

151.5

73.7

24.2

136.7

53.5

27.4

Days

5.4 7.6

7.5 9.9

6.8 9.9

12.0 6.5

4.3 10.4

5.6 7.2

5.2 ●

4.7 8.2

3.6 7.6

2.5 2.7

3.0 8.1

6.1 11.0

3.7 5.9

6.2 7.3

8.0 9.9

3.2 4.9

'Marrualoft@a lrrtamakfral Statisti\Classikaksr of Diseases, /njurkwaralCauaesofDaath(bssedonrecemmerxlationsof theNinthReviekmC0nferenCS, 1975).

‘Includaadiagnosticconditionsrmtshownin tebla,

NOTE Dataamforshoti-stay non-Ftieml hospitals intk Unitti Stitesad forshod-stay Wspital se*sin Frne. Patik Wmfiti WtiWarg@on ti-ti@amexd@.

60
TdNe24. MmofdMMws and~ofmm, andavem knmsofaWy tir@@nts -yeamof w*h@tisM+tiy~w

~qbyaafected cliegnoaticcstegary: United States and Frsnce, 1981

Average length

Discharges Days of care of stay

,

United United United

Diagnostic category and ICB9 code’ States France States France States France

Rate per 1,000 population flays

Allmnditions 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191.6 133.4 1,560.4 1,574.1 8.1 11.8

Neoplasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 20.2 19.2 201.3 226.6 10.0 11.6

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140-208,23G234 16.0 11.1 173.7 142.1 10.8 12.8

Endwfine, nutritional andmetabhc diseases, andimmuniW dsorders. . . . . . . . . . 240-279 8.2 6.6 75.1 137.3 9.1 15.6

Mentaldkorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29N19 9.9 9.0 117.2 148.5 11.9 16.5

Dlseasesofthecirculatorysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390459 39.3 15.2 339.8 249.3 8.6 16.4

Diseawofthedigestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579 26.6 14.1 217.7 138.2 7.6 9.6

Diseases of themusculoskeletal system andconnective tissue. . . . . . . . . . . . . . 710-739 16.4 11.4 131.7 117.4 6.0 10.3

In]uryandpoiaoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-999 13.9 15.9 113.6 117.7 8.2 7.4

~Manua/of ffw/ntarnafiwra/Sfafisfks/C/aasificatiorrof Diseases,/njuriasand Causesof Daath(basadon recommetiatiins of thet+inth Revk”m Conference, 1975).

%oludsa dlsgnostlc corulltbns not afmwn In table.

NOTE Dataare forshod-stay non-FWsral hos@lals lnthe Unitti8htes mdforshofl-stay hospital aewkesin Frwe. Patients admtiti tid*ha@ ~tiesamedate areexclW.

Tsbfe 25. Rates ofdxti~ea and@ysof mm, andave~kn@hs ofsWyfw ptents65yeam d~andovar tih@fmsM+tiy~w

servfceq byaefectedd~nosticcs- UnitedStsteaandFrance, 1861

Averageierrgth

Discharges Daya of care of stay

United United United

Diamostic cateaorv and [CD-9 code’ States Frame States France States France

Rate per 1,000 LtOPUlafiOn Days

Allcondltionsz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignantneoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140-208.230-2~

Mentaldisordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29~19

Diseasasofthenarvoussystemandsense organs . . . . . . . . . . . . . . . . . . . . 320-369

Diseasesofthecirculatorysystem.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 390--459

Heartdlsease . . . . . . . . . . . . . . . . .391 -392.0,393-398,402, 404,410-416,420-429

Diseaeesoftherespiratorysystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460-519

Diseasesofthedigestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-579

Diseasesofthegenitourinarysystem . . . . . . .. . . . . . . . . . . . . . . . . . . . 580-629

Symptoms, signs, andill-definedconcfitions . . . . . . . . . . . . . . . . . . . . . . . . 780-799

Injuryandpoisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999

Fractureofneckoffemur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...620

391.4 239.6 4,150.2

41.5 29.4 518.9

37.2 20.3 482.6

9.8 12.4 137.9

27.2 17.6 160.5

111.9 52.7 1,236.7

71.5 15.6 741.5

38.1 16.5 392.2

50.5 21.1 462.1

26.9 15.2 236.4

3.7 15.1 25.8

26.6 21.7 350.3

6.7 12.6 140.1

4,288.8

523.3

●

270.3

254.5

901.2

246.5

389.4

327.0

268.6

252.2

399.3

160.5

10.6 17.2

12.5 17.6

13.0 ●

14.1 21.8

5.9 14.3

11.1 17.1

10.4 15.8

10.3 23.6

9.5 15.5

8.8 19.0

7.0 16.7

13.2 16.9

20.6 14.1

lMarwa/oftha hrtamatiorra/Stafistica/C/assifkatiorrofDiseases, /q"uties ati Causes of@ath(based onrecommendations of the Mnti Retisim Inference, 1975).

21ncludes diagnoslk condil!ans not strewn in table.

NOTE Dataare forshofi-stay non-FWeral hospitals inthe UnitWStates and forshoti-stay hospital sewices in Frwe. Patien@ admitied atiti*arged ontiesme date aeexcluM.

61
Table 28. Retea of dfacharges”anddays of care for patients 15 yeare of age and over dieoharged from shwkatay hoepWa or service% by age ●nd rneritaf

atetuw UnftadStetea and France, 1961

15-44years 45-64 years 66 yaacs and over

United United United

Marital status States France States France Statas Frarrcw

Discharges per 1,000 population

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143.3 128.9 192.7 133.4 4f6.3 239.6

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157.3 138.9 170.7 112.5

Single . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

346.6 236.6

104.0 94.4 307.8 189.6 525.6 164.4

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176.9 ●

206.8 124.4

Dhrorcedorseparatad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

443.9 231.8

133.1 ●

169.1 ●

310.3 ●

Daya of care per 1,000 population

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767.4 1,005.4 1,56s.7 1,574.1 4,413.7 4,288.8

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 765.1 1,069.5 1,308.6 1,280.0 3,371.5 4,008.5

Single . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598.3 717.4 2,924.0 3,568.2

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6,420.9 2,979.9

1,128.2 ●

1,927.2 1,716.7 5,045.3 4,381.0

Oivorcedoraaparatecf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867.8 .

1,557.7 .

3,452.5 ●

NOTE U.S. ra!eswem mpu!@usi~esllmatea of thectihan noninsfitiona~zed ~laHonaM &wtmabh Wratesin ~eoWrtiMes inttiare~fl, tiitiwere m@dusi~the@ilian

rssfdantfmpulatbn. U.S.datsare forsWt-etayn on-Facferalkspifals. Franchdata are forshorf-s!ay twspitalaaw”ws. Patienfs admitfad andsfischarged onthesama dstesmexclti.

Tabfe27. P~nt~tnWmnsofdscha~esanddaysof~mfor@kntaWhar@frmakR%tayk~korwWsbymWsMuq-Wg~

egw Unfted Stetesand Frence, 1981

All ages Under 15 yeara 15-4V yeara 45-64 yeara 65yearsandovar

United Unitad United United Unitad

Marital status States France States France States France States France States France

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Married . . . . . . . . . . . . . . . . . . . . . . . .

Single . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed...............). . . . . . .

Divorcadorseparated . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Married . . . . . . . . . . . . . . . . . . . . . . . .

Single . . . . . . . . . . . . . . . . . . . . . . . . .

Widowed . . . . . . . . . . . . . . . . . . . . . . .

Divorcedorseparatad . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . .

100.0 100.0 100.0

50.7 51.6 ‘0.3

24.4 27.9 97.9

12.6 11.0 ●

6.3 2.2 ●

6.0 7.2 1.7

100.0 100.0 100.0

47.5 50.2 ‘0.3

20.3 23.5 97.7

18.7 17.9 ●

6.9 2.0 .

6.6 6.4 1.9

Percent distribution of discharges

100.0 100.0 foo.o i 00.0

56.0 56.6 6s.3

99.1 28.7 30.7 7.6

0.6 ‘ 8.5

8.3 ●

9.0

*

6.4 6.2 6.6

Percent distribution of days of osre

100.0 100.0 100.0 100.0

60.9 58.0 64.3

99.7 30.6 29.9 8.9

0.7 ● 9.7

10.1 ●

10.2

* 7.5 8.9 6.9

100.0

67.4

12.4

6.7

●

9.3

100.0

84.0

19.8

7.6

●

4.9

100.0

45.9

6.6

37.9

3.4

6.3

100.0

41.8

7.6

40.6

3.5

6.5

100.0

49.3

5.6

37.8

●

6.0

100.0

46.3

6.0

39.9

●

6.3

NOTE Dataarefor s~R-a!aynon-F#eral hos@lalsinthe Unit* S~tesandfor shod-atayhospiWf aaWesin Frwe. Ne~minfmkati ~tien~admtiti ~dtir@mtiamm dale

am excluded.

Table 28. Ave~kn@a ofsWyfor patknts tischa@ fmskti-hy k-orsewtiS ~~andmtilstitus: United States

andFrence,1981

All ages Under 15 yeaffi 1544 years 45-64 years 65 years and over

United United United Unitad Unitad

Marital status States France States France States France States France States France

Average length of stay in days

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 7.4 11.2 4.8 8.1 5.4 7.8 8.1 11.8 10.6 17.9

Married . . . . . . . . . . . . . . . . . . . . . . . . 6.9 10.6 ‘4.5 - 4.9 7.7 7.7

Single . . . . . . . . . . . . . . . . . . . . . . . . . 6.1

11.2 9.7 16.6

9.4 4.8 8.1 5.8 7.6

Widowed . . . . . . . . . . . . . . . . . . . . . . .

9.5 18.8

10.9

12.2

16.1 .

19.3

6.4 .

Divorcedorseparatad . . . .. . . . . . . . . . . . . 6.1

9.3 13.8 11.4

10.0 ●

18.9

6.5 ●

9.2 ●

Unknown . . . . . . . . . . . . . . . . . . . . . . . 8.1

11.1 ●

9.9 5.4 “ 6.2 8.5 8.5 6.2 10.9 18.7

NOTE Dataare forshod-stay non.Ftieral hos@talsinthe UnitWStates and forshod-sby hospital seMcesin Frame. Ne~minfank atipatien@ admiR@and ditisrjW onthe same date

are excluded.
Tsb!e 29. Percent distrfbuths snd average fengtha of stay for Ps8anta dkhswed from 8h0ft-StSy h0?@at8 or SefViOeS by ~==@Kftisw “

Unitsd states and Fmrwe, 1981

All ages Under 15 years 1544 yeara 45-64 years 65 yeara and over

Unitad Unitad United Unitad Unitad

Disposition States France States France States France States France States France

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Home/routine . . . . . . . . . . . . . . . . . . . . .

Transfer . . . . . . . . . . . . . . . . . . . . . . . .

Death . . . . . . . . . . . . . . . . . . . . . . . . .

Other/notstatad . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Home/routine . . . . . . . . . . . . . . . . . . . . .

Transfer . . . . . . . . . . . . . . . . . . . . . . . .

Death . . . . . . . . . . . . . . . . . . . . . . . . .

Ofher/notstated . . . . . . . . . . . . . . . . . . . .

100.0 100.0 100.0

83.0 87.4 88.2

4.1 8.5 1.5

2.4 2.1 0.7

10.6 2.1 9.5

7.4 11.2 4.8

6.9 10.4 4.7

14.3 17.3 8.9

14.5 22.7 12.7

7.0 9.9 4.6

Percent distribution of discharges

100.0 100.0 100.0 100.0

91.3 87.4 92.4 83.9

●

1.3 5.0 2.8

0.3 .2.3

.

10.9 .

11.0

Average length of stay in days

e.1 5.4 7.8 8.1

7.9 5.3 7.5 7.9

.

10.7 13.1 12.6

15.5 .

14.9

●

5.2 “ 7.6

100.0

86.9

8.8

●

.

11.8

11.2

16.6

.

●

100.0 100.0

73.8 77.6

10.0 14.6

6.1 6.4

10.0 .

10.6 17.9

9.7 16.6

15.6 21.9

14.4 23.8

10.1 ●

NOTE Dataamforshoti-stay non-F@eral hospihls lntie United States mdforsb~-s~y Ws@mlsetis in Frm. Newbminfmk mdpatienk WmM~ati d*~dm Me Smdate

are axcluded.

TAAs30. Wmnttit-sofd_sand&yaofumforxn&@-_*-stiy_w**sbyW*ofaocordhgtosgeofpstfenk UnitedStstesandFmtw% 1981

All ages Under 15 years 1544 years 45-64 yeara 65yeara and over

United United United United United

Hospital size States France States France States France States France States France

Alleizea . . . . . . . . . . . . . . . . . . . . . . . .

Fewarthan 50 baas . . . . . . . . . . . . . . . . .

50-119beds . . . . . . . . . . . . . . . . . . . . .

120-399bede . . . . . . . . . . . . . . . . . . . .

4oo-799bads . . . . . . . . . . . . . . . . . . . .

800-l,399becfe . . . . . . . . . . . . . . . . . . .

l,400bedsormore . . . . . . . . . . . . . . . . . .

Alleizee . . . . . . . . . . . . . . . . . . . . . . . .

Fewerthan50bads . . . . . . . . . . . . . . . . .

50-119beds . . . . . . . . . . . . . . . . . . . . .

120-399beda . . . . . . . . . . . . . . . . . . . .

4oo-799beds . . . . . . . . . . . . . . . . . . . .

800-l,399beds . . . . . . . . . . . . . . . . . . .

l,400badsormore . . . . . . . . . . . . . . . . . .

100.0 100.0

5.6 7.4

15.5 17.6

46.4 17.5

27.8 18.7

4.3 7.6

0.5 31.2

100.0 100.0

4.4 5.7

13.4 19.4

48.1 21.5

30.3 20.2

5.2 5.6

0.5 27.6

100.0

4.3

20.2

44.3

26.2

4.3

0.6

100.0

3.0

17.3

40.5

31.6

6.6

0.9

Percent distribution of discharges

100.0 100.0 100.0 100.0

●

5.2 9.4 5.4

.

14.5 20.3 14.2

13.4 46.1 14.0 45.5

20.9 29.0 17.8 29.9

13.6 4.5 7.7 4.7

34.9 0.7 30.8 0.4

Percent distribution of days of care

100.0 100.0 100.0 100.0

●

4.0 6.0 3.9

●

13.6 24.0 12.1

14.8 43.8 15.1 44.8

25.5 31.9 17.9 32.7

11.5 5.8 7.1 6.0

33.6 0.9 29.9 0.4

100.0 100.0 100.0

6.8 7.0 ●

22.7 16.4 11.9

19.2 46.1 23.9

16.0 24.8 22.0

6.2 3.5 5.7

29.1 0.2 32.3

100.0 100.0 100.0

3.7 5.3 ●

28.0 13.6 13.5

20.3 49.4 28.3

16.0 27.4 23.0

4.2 4.1 4.0

27.8 0.3 24.7

NOTE: Damamrmshon-sIay M-FWeral hos@tils inti Unitti Sktesad forsbti-sWy MM**in Fr-. NeWminfmk dpak*timMd tidbwgdatie_dtie

am excluded.

63
Table 31. Average kmgfhs of stay for patients &echarged from short-stay ImepWa or

and France, 1961

s=vif=% byew+ofpatient and bedaizaofhowitek United 3tetes

All ages Under 15years 15-44 years 45-64 years &5years and over

United United United United United

Hospital size Statas France States France States France States France States France

Average length of stay in days

All sizes . . . . . . . . . . . . . . . . . . . . . . . . 7.4 11.2 4.8 8.1 5.4 7.8 8.1 11.8 10.6 17.9

Fewer than50 beds . . . . . . . . . . . . . . . . . 5.8 8.4 3.4 .

4.2 4.9 6.0 6.3 8.1 *

50-119beds . . . . . . . . . . . . . . . . . . . . . 6.4 12.2 4.1 .

5.0 9.2 6.9 14.2 8.7 19.6

120-399 beds . . . . . . . . . . . . . . . . . . . . 7.3 13.7 4.4 9.2 5.1 6.5 6.0 12.2 10.9 20.8

400-798 beds . . . . . . . . . . . . . . . . . . . . 8.0 12.1 5.8 10.0 5.9 7.7 8.9 12.1 11.7 19.3

600-l,399kds . . . . . . . . . . . . . . . . . . . 9.1 8.3 7.4 6.9 6.6 7.2 10.5 8.5 12.6 13.1

l,400kts or more . . . . . . . . . . . . . . . . . . 8.2 9.2 7.1 7.6 7.1 7.6 8.9 11.4 13.5 13.8

NOTE Dataarefor Wofl-slaynm-Fderal ks@blsintk Unitti Shtesand forshoti-stay hw@talwtis in Fr-. Netiminfmk ati@tients admMtiti dAa@Mtie=mdaIe

are excbded.

Tabkr 32. Fercent distributionsof discharges and days of care, and average lengths of stay for patients cEachargadfrom short-stay hoe@efe or eervioas

by ownership of _ wmrding to age of patient United Statea and Fmnce, 19S1

All ages Under 15years 15-44 years 45-64 years 65years and over

United Unitad United United

Ownersh@

United

States France States France States Frams States France States France

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Private nonprofit . . . . . . . . . . . . . . . . . . .

Private forprofit . . . . . . . . . . . . . . . . . . . .

Public . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Private nonprofit . . . . . . . . . . . . . . . . . . .

Private forprofit . . . . . . . . . . . . . . . . . . . .

Public . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . .

Private nonprofit . . . . . . . . . . . . . . . . . . .

Private forprofit . . . . . . . . . . . . . . . . . . . .

Public . . . . . . . . . . . . . . . . . . . . . . . . .

100.0 100.0

70.6 10.1

7.9 27.7

21.5 62.2

100.0 100.0

72.2 15.3

8.1 26.8

19.7 57.9

7.4 11.2

7.5 16.7

7.6 10.7

6.8 10.3

100.0

71.7

5.2

23.7

100.0

70.9

4.2

25.0

4.8

4.8

3.6

5.1

Percent distribution of discharges

100.0 100.0 100.0 100.0

12.2 69.3 6.4 72.1

19.6 7.7 32.4 6.6

68.2 23.0 61.2 19.4

Percent distribution of days of care

100.0 100.0 100.0 100.0

17.7 69.6 9.6 73.0

16.1 8.6 31.8 8.3

66.2 21.8 58.4 18.7

Average length of stay in days

8.1 5.4 7.8 8.1

11.7 5.4 11.9 6.3

6.6 6.0 7.6 7.9

7.8 5.1 7.4 7.6

1OQ.o

13.6

31.6

54.7

100.0

20.5

27.6

51.9

11.8

17.6

10.3

11.2

100.0

71.3

8.5

20.2

100.0

73.9

8.2

17.9

10.6

11.0

10.2

9.4

100.0

12.5

19.1

66.4

100.0

15.3

21.1

63.6

17.9

21.6

19.7

16.6

NOTE Datsarefor ekd.stay~n-Fedaral hosptials intk Untid Sbtesatifor skti-stay k~iQlsetims in Frw. Netiminfan@ W~Mn&admiUd mddW_ontimdata

are excluded.

64
Table 33. *mnt&tnWmns oftiwhawes sndavewe lenMsds@y for@n@dmcbw4 fr~sb~-stay b~kor**aby=u=of

PSWtWnk lhIttad Stafesand FrnnQ% 1981

Percent distribution Average length

Source of payment of discharges of stay in days

United States

Allsources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...”””

Privateinsurance . . .$....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........

Semndsourceprivsteinsurance.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SecondsourceMedicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .........

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Workmen’sCompansation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...+-....

Self-pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allsources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sick fund, 100-percent coverage:

Maternity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Workmen’sCompansatlon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sick fund, copayment caquired:

Withsupplementarycoverage.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Withoutsupplementarycoverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......

Otherandnotstated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

51.1

29.8

13.7

3.3

9.0

1.7

5.1

3.4

100.0

9.2

2.2

51.6

17.2

15.4

4.7

7.4

5.9

10.5

10.2

10.9

6.5

6.6

5.8

6.4

France

11.2

8.7

7.8

13.9

7.8

6.6

8.6

NOTE: Dalaare forprid~l sx@tiarmof payment fordtiarges frmshoti-atay rim-Federal kspitals intie Unitti States dforwurceof payment forti*harges from shoti-stay

hospital services in France. Newborn infants and patients admitted and dischargwl on the same date are excluded.
Appendixes

Contents

I. Hospital discharge data systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. O. O.< .67

11. Technical notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

III. Definitions of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..7g

Listof appandixfigures

I. Medical Abstract for the National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

H. Approximate relative standmd emomfor estimated numkmof patienk tischwged or fordiagnoses, byselwted hospital

characteristics: United States, 1981. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..73

III. Approximate relative standard errors for estimated numbers of days of care, by selected hospital characteristics: United

States, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

IV. Approximate relative standard errors for estimated numbers of patients discharged or diagnoses and for numbers of days

ofcare: France, 1981..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...76
Appendix 1

Hospital discharge data systems

Characteristic United States France

Data system The National Hospital Discharge Survey (NHDS) is

conducted by the National Center for Health Statistics

(NCHS).

Background The survey has been in operation continuously since

1965. The original universe for the survey consisted

of the 6,965 short-stay hospitals listed in the 1963

National Master Facility Inventory (NMFI). The NMFI

is a comprehensive list of hospitals, nursing homes,

and other inpatient facilities in the United States developed by NCHS. A detailed description of the NMFI

has been published (NCHS, 1965). The universe was

updated in 1972, 1975, 1977, 1979, and 1981. In

1981, in addition to the original hospitals, the universe

included 1,115 new hospitals.

Scope Hospitals in the 50 States and the District of Columbia

in which the average length of stay is less than 30

days are covered by the survey, with the following

exceptions: institutional hospitals, such as prison hospitals and university student health centers; Federal hospitals, such as military and Veterans’ Administration

hospitals; and hospitals with fewer than six beds. Patients in long-term care units of hospitals covered by

the survey are excluded if the units keep records separately from the rest of the hospital. Discharges of

newborn infants are covered but are excluded from

the totals in this report.

Sample size In 1981 the NHDS sample consisted of 550 hospitals.

Of these, 71 refused to participate and 51 were out

of scope either because the hospital had gone out of

business or because it failed to meet the definition

of a short-stay hospital. Thus, 428 hospitals participated

in the survey during 1981, and they provided approximately 227,000 abstracts of medical records.

NOTE Alistofreferencesfollowsthetext.

The hospitalization survey was camied out by the Medical Economics Division of the Centre de Recherche

pour L’Etude et L’Observation des Conditions de Vie

(CREDOC), which is now the Centre de Recherche

D’Etude et de Documentation en Economic de la Sant6

(CREDES).

The survey was canied out in two stages. The first

stage, a survey of hospital institutions, was conducted

from October through December 1980. The second

stage, a survey of hospital departments that were open

to patients, was undertaken from February 1981 to

January 1982. The universe of hospital institutions

was the Repertoire des etablissements d’hospitalisation

publics et prives (Directory of Public and Private Hospital Institutions), which was drawn up by the Health

Ministry in 1977. The directory lists all short-term,

medium-term, and long-term general and specialized

hospitals, including psychiatric hospitals. A total of

3,615 hospital institutions, both public and private,

were included.

All hospital institutions in France were included in

the universe with the exception of military hospitals.

The universe did not include hospitals in overseas territories. Infirmaries within residential institutions, such

as old people’s homes, prisons, and convents, are not

defined as hospital institutions and were not included.

Hospice sections of general hospitals were not included.

Hospice care is similar to the services provided in

U.S. nursing homes. In this report, data on mediumterm and long-term services were excluded, and only

data on discharges from short-term services were compared with U.S. data.

The sample for the first stage of the survey consisted

of 363 hospital institutions. Of these, 17 were out

of scope because they had converted to other types

of institutions or had closed, and 50 hospitals declined

to take part in the survey. Because of differential sampling rates, the corrected overall refusal rate was 18.1

percent. The 296 responding hospitals included 3,178

departments that were open to patients (27.3 percent

of all such departments) and 221,335 beds (35.5 percent

of all hospital beds).

67
Characteristic United States France

Sample size

(continued)

Sample design A two-stage, stratified sampling design is used in the

survey. The first stage is selection of a sample of

hospitals. The primary stratification variables are bed

size and geographic region. Hospitals are selected in

direct proportion to size. Hospitals with 1,000 beds

or more in the universe of short-stay hospitals have

sampling probabilities of certainty, and the sampling

probability decreases to 1 in 40 for the smallest

hospitals.

The second stage is a systematic sample of discharges

from the sampled hospitals. The discharges are selected

in inverse proportion to hospital size to compensate

for the higher probability of selection of the larger

hospitals, This ensures that the overall probability of

selecting a discharge is approximately the same in

each size class.

The sampling frame in nearly all the hospitals is

the daily listing of discharges. A systematic sampling

technique is used, usually based on the terminal digit

of the patient’s medical record number.

Data collection An abstract form is completed for each sample disproeedures charge, using information from the patient’s medical

record. In about half of the hospitals that participated

in the survey during 1981, the sample selection and

abstracting were done by the medical records staff

of the hospital. In the other half of the hospitals,

the work was performed by personnel of the U.S.

Bureau of the Census, acting for NCHS. Completed

abstracts, along with sample selection control sheets,

are sent to a Census Regional Office, where the forms

are checked for completeness. The abstracts are next

sent to NCHS, where all abstract information, including

diagnoses and surgical procedures, are coded. The data

are then transferred to computer tapes, edhed, and

processed.

as

In the second stage of the survey, a sample of 301

departments was obtained from the 3,178 surveyed

in the first stage. To ensure that the necessary number

of departments would be included in the survey, a

total of 443 were drawn, and when a department refused

to participate, it was replaced by another with similar

characteristics.

Data were obtained from the records of 4,140 hospitalized patients from the 301 departments. This sample was divided into two sub-samples: 1,911 patients

occupying beds at the time of the survey (sampling

ratio l/266) and 2,229 discharges who left the department during the observation period (sampling ratio

l/4,5 12). A total of 1,665 discharges were from shortstay hospital services.

A three-stage, stratified sampling design was used in

the survey. In the first stage, selection of a sample

of hospitals, the hospitals were drawn in direct proportion to size. Hospitals with 4,000 beds or more had

a sampling probability of certainty, and the sampling

probability decreased to approximately 1 in 40 for

hospitals with less than 50 beds. For the second stage,

selection of hospital departments, sampling probabilities were based on the size of the hospital and

the size of the department.

In the third stage, all patients discharged from a

sampled department during a set observation period

were included in the sample. The observationperiod

was 1 day for the largest departments, but as long

as6 days for the smallest departments.

The sampling rate at each stage was calculated so

that each patient hospitalized in France during 1981

had the same likelihood of being included in the sample.

In practice, because of refusals and technical constraints, the final sample was slightly distorted, and

correction factors had to be introduced.

In the first stage of the survey, a hospital questionnaire

was completed by staff of the 296 hospitals participating

in the survey, In the second stage, completion of a

departmental questionnaire was the responsibility of

physicians in the 301 participating departments. In

the third stage, the patient questionnaire was completed, or atleast the medical information was recorded,

by a department physician. A special telephone service

was set up at CREDES (at the time the Medical

Economic Division of CREDOC) to assist hospital

management staff and physicians with the questionnaires and to answer any questions.

CREDES had the responsibility for coding the data

from the questionnaires. Sociodemographic data were

coded by a team of three people working under the

guidance of a demographer-sociologist. The coding

was based on classification systems of the Institut National de la Statistique et des Etudes I%onomiques
Characteristic United States France

Data collection

procedures

(continued)

Items collected

Medical coding

Missing data

The abstract form (figure I) used in the NHDS includes

items for patient identification, such as hospital, survey, and medical record numbers; date of admission

and discharge; and ZIP Code of residence. Patient

characteristics recorded include sex, date of birth or

age, race, ethnicity, marital status, expected source

of payment, and the dkcharge status and disposition

of the case. The medical information consists of discharge diagnoses, surgical and diagnostic procedures,

and the dates of procedures. Diagnoses and procedures

are listed, with the principal diagnosis (or the one

listed first, if a principal one is not identified) followed

by the other diagnoses as entered on the face sheet

of the medical record.

Diagnoses and procedures listed on the NHDS abstract

are coded using the International Classijlcation of Diseases, 9th Revision, Clinical Modification (ICD-9–

CM) (U.S. Public Health Service and Health Care

Financing Administration, 1980).

In 1981, the age and sex were missing from the face

sheet of the medical record in fewer than 0.25 percent

of cases. When these items were missing, imputations

were made by assigning the patient an age or sex

consistent with the age or sex of other patients with

the same diagnostic code. In the rare instances when

dates of admission or discharge could not be obtained,

a length of stay was imputed by assigning a length

of stay characteristic of other patients of the same

age.

(INSEE). Medical data were coded by a team of physicians. The coding operation lasted approximately 1

year. The coded data were transfemed to computer

tapes and analyzed.

Copies of the hospital, department, and patient questionnaires have been published (Lecomte et al., 1980).

General information about the characteristics and facilities of the hospitals was collected with the hospital

questionnaire. A detailed list of the departments with

hospital beds was also obtained, which included the

specialty practiced in the department and the number

of beds.

The questionnaire sent to the departments contained

questions about the specialty, status, and size of the

department, personnel, facilities, and activities, and

a listing of beds.

The patient questionnaire was approximately 40

pages long and contained detailed questions in four

major areas:

(1) Sociodemographic characteristics of the patient

such as sex, date of birth, residence, nationality, marital

status, health insurance coverage, principal activity,

occupation, education, and housing conditions.

(2) Information about admission, discharge, and hospital stay, including dates of admission and discharge,

source of admission, type of hospital room, amenities

available during hospital stay, disposition at discharge,

and post-discharge treatments recommended.

(3) Consumption of medical care, including surgery,

radiology, laboratory tests, other clinical tests, care

and treatments from physicians and ancillary medical

personnel, nursing care, and consumption of pharmaceuticals.

(4) Morbidity, including reason for admission, admission diagnosis, clinical status at time of the survey

or discharge diagnosis, medical and surgical history,

prognosis, and degree of disability.

The morbidity data was coded using the Manual of

the International Statistical Classzjication of Diseases,

Injuries and Causes of Death, based on the recommendations of the Ninth Revision Conference (ICD-9)

(World Health Organization, 1977).

Sex was reported for all the patients in the French

survey. Age was reported on all but 18 of the patient

questionnaires and diagnosis was missing from 65.

Tabulations from the survey only include patients with

known responses. Nonrespondents are assumed to be

distributed the same as respondents.

NOTE A listof referencesfollowsthe text,

69
.CONFIDENTIAL - All information which would permit identification of an indwidualor of an establishmentwill be held confldantial, will be usedonly

by personsengaged.m and for the purpos-ssof the suwey, and WIIInot be disclosedor releasedto other parsonsor used for any other purpoaa.

:~~2H DS-I DEPARTMENTOFHEALTHANDHUMANSERVICES

,. U.S. PUBLICHEALTHSERVICE

NATIONALCENTERFORHEALTHSTATISTICS

MEDICAL ABSTRACT – NATIONAL HOSPITAL DISCHARGE SURVEY

k.PATlENT IDENTIFICATION Month Day Year

1. Hospital number.. . . . .“. . . . . . I 4. Dateofadmission. . m-m-m

2. HDSnumber . . . . . . . . . . . . . . . I 5. Dateofdischarge ..m-m~m

3. Medical record number 6. Residence ZIP code

3, PATIENT CHARACTERISTICS

8. Age [Complete only if date of

Umts 1IJ Years

Month Oay Year

m{ 2❑ Months

7. Date of birth m- m– ~ bir’hnotg’van) ””””””””””””” s❑ Oays

9. Sex (Mark (X) one) I

I

I ❑ Male 2❑ Female 3❑ Not stated

10. Race I I❑ White 3 ❑American lndlan/Alaskan Native 5U Other (Spamfy)

\ ‘n Black 4 G Asian/Pacific Islander s❑ Not stated

I

11. Ethnicity (Mark (%)one) I I ❑ Hispanic origin 2❑Non-Hispanic 3~ Not stated

12. Marital status I I ❑ Married 3❑ Widowed 5❑ Separated

(Mark (X) one) I

2Cl Single i U Oivorced 6 u Not s!ated I

13. Expected source(s) of payment Principal Otheradditmnal

(Markoneonly)

14. Status/Disposition of patient

sources

(Markaccordingly) (Mark (X) appropriate box(es))

{

1.Workmen% Compensation . . . . . . . ❑ ❑

Status Oviposition

Z. Medicare . . . . . . . . . . . . . . . . . . . . . . .

Ii •1

I ❑ Alive ● ● .❑ Routine diachar!#a/

Government 3. Medicaid

discharged home

aourcea

. . . . . . . . . . . . . . . . . . . . . . .

•1

4. Title V . . . . . . . . . . . . . . . . .

b. ❑ Laft againat madiial advka

5. Other government payments . . . . . . ❑ : c”❑ ~%%%’%;~~t%

Private

(.

&Wue CrOss . . . . . . . . . . . . . . . . . . . . . ❑ •1

sources 7. Other private or commercial d. ❑ Oiacharrlecf.transferred to

insurance . . . . . . . . . . . . . . . . . . . . . . •1 ❑

Iongterm care institution

{

E.Self pay . . . . . . . . . . . . . . . . . . . . . . .

Othar

•1 ● .O Oiapositionotatatad

●ourcea

9. Nocharge . . . . . . . . . . . . . . . . . . . . . .

: •1

10. Other LS@cify/

. . •1 •1

2❑ Oied

❑ NO source of payment indicated 3 ❑ Status notstatad

2. FINAL DIAGNOSES

Principal:

Other/additional:

❑ Seerevarsaside

), SURGICAL AND DIAGNOSTIC PROCEDURES 0::;:

Month veal

Principal: m-m-m

Other/additional: m-m-m

m-m-m

—— m-m-m

lJNONE- ❑ Sss reverse side

~ompleted by Date

F@urel. Medioalafxatractforthss Na60naf Hos@s)l~8urvey
Characteristic United States France

Release of data Annual reports of data from the survey are published

by NCHS in Advance Data and in Vital and Health

Statistics, Series 13. These reports update data on hospital utilization, diagnoses, and procedures, by characteristics of patients and hospitals. Special reports are

also published on selected topics, such as expected

source of payment, hospital use by children, and diagnosis-related groups (DRG’s). Unpublished data from

the survey are available on request from the NCHS

Division of Health Cam Statistics, and data for 1970

and subsequent years are available on public use tapes.

Data from the survey have been published in the following CREDOC publications: Les Etablissements Hospitaliers en 1980: Premiere Phase de L’Enquete Hospitalisation (Com-Ruelle et al., 1982). Enquete sur

les Hospitalises: Modalities et Realisation de CEnquete (2it?mePhase), Socio-Demographic de L’Echantillon (Com-Ruelle et al., 1983), and Enquete sur les

Hospitalise: La Morbidite Hospitaliere (Com-Ruelle,

1984).

No’1’13A listof referencesfollowsthetext.

71
Appendix II

Technical notes on methods

Characteristic United States France

Estimation

Measurement

error

Sampling error

Statistics produced by the National Hospital Discharge

Survey (NHDS) are derived using a complex estimating

procedure. The basic unit of estimation is the sample

inpatient discharge abstract. The estimating procedure

used to produce essentially unbiased national estimates

in NHDS has three principal components: inflation

by reciprocals of the probabilities of sample selection,

adjustment for nonresponse, and ratio adjustment to

fixed totals. These components of estimation are described in appendix I of two earlier publications

(NCHS, 1967a, 1967b).

As in any survey, NHDS data are subject to reporting

and processing errom and errors due to nonresponse.

The reliability of the abstracting and coding of NHDS

data have been studied by the Institute of Medicine

(IOM). The dates of admission and discharge, as well

as patient’s age, race, marital status, and disposition,

were found to be highly reliable. The reliability of

data on diagnoses and procedures was found to vary

by level of coding specificity. Reliability increased

when codes were condensed from four to three digits

and was highest for codes grouped into the major

diagnostic categories. A detailed account of these and

other findings from the IOM study has been published

(InstituteofMedicine, 1980).

The standard error is the sampling variability that occurs by chance because only a sample, rather than an

entire universe, is surveyed. The relative standard

error of an estimate is obtained by dividing the standard error by the estimate itself and is expressed as a

percent of the estimate. The relative standard errors

applicable to estimates of patients discharged or

diagnoses are shown in figure II. Relative standard

errors for estimates of days of care are shown in figure 111. In these figures, several curves are shown

beeause some variables have relative standard errors

different from those in the curve for “All other variables” that is relevant to most estimates. For example, one curve in figtue 11is applicable only to estimates of discharges from hospitals with less than 50

beds.

National estimates for 1981 were obtained from the

French survey by multiplying each discharge in the

sample by the product of the reciprocals of the probabilities of sample selection at the three stages: (1)

selection of the hospital establishment, (2) scketion

of hospital department, and (3) selection of discharge.

In addition, the estimates for short-term services were

multiplied by a correction factor (1.0682) to adjust

for nonresponse and the undersampiing that resulted

from technical constraints.

The main source of possible bias in the French hospital

survey data is the different levels of response by different types of hospitals. Response rates varied from 84

percent for public hospitals to 56 percent for private

for-profit hospitals. Hospitals with less than 120 beds,

many of which were private for-profit hospitals, had

lower response rates than larger hospitals. The hospitals

in the areas around Paris and the Mediterranean, where

private for-profit hospitals are most important, also

had lower-than-average response rates. Adjustments

were made for the dMferences in response rates, assuming that the nonrespondinghospitals,in the aggregate,

weresimilarto the respondinghospitals.

Sampling variances for the data on use of shofi-term

hospital services from the French survey were approximatedby a balanced repeated replication(BRR)

procedure based on 12 half samples. The procedure

assumes a probability sample of discharges. However, the selection of substitute departments to replace nonresponding departments in the second stage

of the survey may not have been random. Approximate variances for aggregated estimates of discharges

and days of care were calculated for a variety of variables, including sex, age, bed size, ownership, disposition, marital status, and diagnostic categories.

Separate relative standard error curves were fit to

these points for discharges and days of care (figure IV).

NOTE A listof referencesfollowsthetext.

72
50

45

40

35

30

25

20

15

10

5

0

50

45

40

35

30

25

20

15

10

5

0

i

2 3 456789

A

2 3 456789

i

2 3 4 56789

i

2 3 4 56789

A

2 3 456789

A

1 10 100 1,000 10,000 100,000

size Of eSfifT7ate in thousands

EXAMPLE: As shown in table 18, the U.S. discharae rate for malkrnant neoDlasms was 8.6 oer 1.000 oomlation, The number of dischames for malkmant neoolasms was aooroximatelv 1.958.000 (8.6 times the population m thousands,

227,659). The relative standard error of this esfima~e as read from-the “All o~her variables” curve was approximately 5,9 percent, The sta;dard error ;f the discharge rate wa~thus ap~r&xlmately 0,51 (5,9 percent of S.6),

Fgure Il. Approximate relative standsrd errors for estimated numbers of patiints discharged or for d~noses, by selected hospitalcharacteristics United Ststes, 1981
50

45

40

35

30

25

20

15

10

5

0

50

45

40

35

30

25

20

15

10

5

I-1

1 23 456789

i

2 3 456789

A

2 3 4 56769 A

2 3 4 56789 A

2 3 456789A

1 10 100

Size of estimate in

1,rio 10;000 1Oo;obo

thousands

EXAMPLE As shown in table 1S, the U.S. discharge rate for malignant neoplaams waa 8,6 per 1,000 population. The number of discharges for mafignant neoplasms was approximately 1.958,000 (8.6 times the population m thousands,

227.659). The relative standard error of this eslimate as read from the “All other variables<’ cwve was approximately 5.9 percent, The standard error of the dkharge rate was thus approximately 0.51 (5,9 percent of 8.6).

Fiiure Il. Approximate relative standard errora for estimated numbers of patiints discharged or for dmgnoses, by sefected hospital charactenstitx United State% 1981-Con.
50

45

40

35

30

25

20

15

10

5

0

50

45

40

35

30

25

20

15

10

5

0

A 23 456789

A

23 456789 A 2 3 4 56789

A

2 3 4 56789

A

2 3 4 56789

A

10 100 1,000 10,000 100,000 1,000,000

Size of estimate in thousands

EXAMPLE: As shown in table 16, the U.S. rate of dsys of csre for females 1-14 years of age waa 208.4 par 1,000 population. The number of days of sere for femalea 1-14 years of age was approximately 4,852,000 (208.4 times the

female population 1-14 years of age in thousands, 23,282). The relative standard error of this estimate, as read from the “All other variables” cuwe was aPPrOximateM 5.9 Wcent. The standard error of the rate of days of care waa thus

approximately 12.3 (5.9 percentof 208.4).

F~ure Ill. Approximate relative standard errore for estimated numbers of days of oare, by selected hospital characteristic= United State% 1981
100

90

80

70

60

50

40

30

20

10

0

A 23 456769

i

23 456789

A

2 3 4 56769

A

2 345

10 100 1,000 10)000

Size Of estimate m Ihousancia

EXAMPLE As shown in table 23. the French discharaa rate for Datients 15-44 veara of aae with the diaanosis of defivenes without Comdications was 18.7 oer 1.000 DoDulatiOn

100

90

80

70

60

50

40

30

20

10

0

6789

A

2 3 456789 A

100,000 1,000,000

The number of discharges In this categow was aPPrOXlmalelY

436,000 (18.7 times the population t 5-44 years of ag~ in thousands, 23,327). The relative-standard error-of this estimate as read from the “O&harges or d!agnoaes” &u&e was approximately 16.1 perc&t The stand{rd error cd the rate was

thus 30 (16.1 percent of 18.7)

.

Fqure IV. Approximate relative standard errors for estimated numbers of patients discharged or diagnoses and for numbers of days of care France, 1981
Characteristic United States France

Presentation Based on consideration of the complex sample design

of estimates of NHDS, estimates derived from a sample of fewer

than 30 records are not reported. Such estimates are

replaced in the tables by an asterisk (*). Estimates

based on a sample of 30-59 abstracts are repotted,

but should be used with caution. These estimates are

preceded by an asterisk (*) in the tables.

Computation With one exception, the population estimates (taof rates ble I) used to compute rates of hospital use are for

the U.S. civilian population on July 1, 1981. These

estimates are from the U.S. Bureau of the Census,

Current Population Reports, Series P-25, No. 917.

The rates of hospital use by marital status are based

on estimates of the civilian noninstitutionalized population in March 1981 as reported in Current Population Reports, Series P-20, No. 372.

Death rates were computed using the resident

population on July 1, 1981, from Current Population

Reports, Series P-25, No. 929.

Tests of The determination of statistical inference was based

significance on the two-tailed t-test using the Bonferroni critical

values for post-hoc multiple comparisons (0.05 level

of significance). Terms relating to differences, such

as “higher” and “lessj” indicate that differences were

statistically significant. Terms such as “similar” and

“no difference” mean that no statistically significant

difference was found between the estimates compared. A lack of comment does not necessarily mean

that the difference was tested and found not to be

significant.

Estimates based on fewer than 20 cases are not reported. These estimates are replaced in the tables

with an an asterisk (*).

The population estimates (table 1) used to compute

French rates in this report are for the legal population

of France at mid-year 1981. The legal population consists of all persons whose usual place of residence

is France, including military personnel stationed within

or outside the country. The estimates are from Institut

National de la Statistique et des Etudes Economiques,

Les Collections deL’INSEE, Series D, No. 90.

The same procedure was followed for comparison of

French estimates and for comparison of French with

U.S. estimates as is described for comparison of

U.S. estimates.

NOTE A list of references follows the text.

77
Appendix Ill

Definitions of terms

Term United States France

Age

Average length

of stay

Bed size

of hospital

Days of

care

Diagnosis

Discharge

Age refers to the age of the patient on the birthday

prior to admission to the hospital inpatient service.

The average length of stay is the number of patient

days accumulated at the time of discharge by patients

discharged during the year divided by the number of

patients discharged.

Size is measured by the number of beds, cribs, and

pediatric bassinets set up and staffed for use by inpatients; bassinets for newborn infants are not included.

The classification of hospitals by bed size is based

on the number of beds at or near midyear, as reported

by the hospital.

The total number of patient days accumulated at the

time of discharge by patients discharged from short-stay

hospitals during the year constitutes days of care. Stays

of less than one day (patient admission and dkcharge

on the same day) were excluded from this report.

For patients admitted and discharged on different days,

the number of days of care was computed by counting

all days from (and including) the date of admission

to (but not including) the date of discharge.

A diagnosis is a disease or injury (or some factor

that influences health status and contact with health

services) listed by the attending physician on the patient’s medical record. A maximum of seven diagnoses

can be abstracted from the face sheet (summary sheet)

of the medical record, but only the principal diagnosis

(or the diagnosis listed first, if a principal diagnosis

is not identified) is used in this report. The principal

diagnosis is the condition established after study to

have been chiefly responsible fo~ occasioning the admission of the patient to the hospital for care.

A discharge is the formal release of a patient by a

hospital: that is, the termination of a period of inpatient

hospitalization. In this report, patients admitted and

discharged on the same day are not counted as discharges. The term “discharge” and “patient discharged”

are used synonymously.

Age is estimated by the difference between 1982”and

the year of birth.

Length of stay is calculated individually for each discharge by calculating the difference between the date

of discharge and the date of admission.

Size is measured by the number of beds installed,

as stated by the establishment personnel. Maternity

bassinets for newborn infants are not counted in the

number of beds.

The total number of patient days accumulated at the

time of discharge by patients discharged from short-stay

hospital services constitutes days of care. Only patients

hospitalized atleast 1night at midnight were included.

A diagnosis is any chronic or acute condition that

required an investigation, care, or treatment during

the course of a hospital stay, as reported by the hospital

physician. There was no predetermined limit on the

number of illnesses or symptoms that could be reported.

The first of the diagnoses that was known at admission

or identified during the course of the stay was used

in this comparison.

The definition isthe same as for the United States.

78
Term United States France

Disposition

Marital status

Ownership

Population

Short-sttiy

hospitals/

services

Source of

payment

The disposition of a patient upon the termination of a

period of hospitalization is classified into one of four

categories in this report. The homeh-outine category

consists of patients who returned to their previous

place of residence after discharge, including patients

discharged to private homes and those discharged to

nonmedical residential facilities, such as prisons, orphanages, and homes for the elderly. Transfers refer

to patients transferred to other short-term hospitals or

to long-term health care facilities (mainly nursing

homes). Deaths are patients who died during an inpatient hospital stay, and the other/not stated category

consists of patients who left the hospital against medical advice or whose dispositions were unknown.

The marital status categories used in this report are

married (which excludes cohabitating persons and married persons living apart temporarily or permanently

because of marital discord), single, widowed, divorced/

separated, and unknown.

Hospital ownership is determined by the organization

that controls and operates the hospital. Private nonprofit

hospitals are operated by a church or another nonprofit

organization. Public hospitals are operated by State

or local governments. Private for-profit hospitals are

operated by individuals, partnerships, or corporations

for profit.

The population estimate used to compute most of the

rates in this report is the civilian population, which

is the resident population, excluding members of the

Armed Forces, on July 1, 1981 (table 1). The rates

of discharges and days of care by marital status are

computed using the civilian noninstitutionalized population 15 years of age and over in March 1981. The

population estimates are based on the 1980 census

and ongoing surveys of the U,S. Bureau of the Census.

Data in this report are for short-stay general and specialized hospitals that have six or more beds and an average

length of stay of less than 30 days. Federal hospitals

and hospital units of institutions are not included.

The principal expected source of payment for a hospital

stay is reported by the patient or the patient’s representative at the time of admission. Private insurance is

insurance provided by nongovernmental sources, including insurance companies, consumers, private industry, and philanthropic organizations. Medicare is

a nationwide program providing health insurance protection to people 65 years of age and over, people

eligible for social security disability payments for more

than 2 years, and people with end-stage renal disease.

Medicaid is a joint Federal-State program that provides

benefits for people, including the elderly, who meet

The home/routine category includes patients discharged to private homes and those discharged to residential facilities, such as retirement homes and hospices. Transfers refer to patients transfemed to other

hospital institutions or to medium or long-stay services of the same institution. Deaths are patients who

died during an inpatient hospital stay, and the otherl

not stated category consists of patients whose destinations were unknown or did not match the listed

categories.

The marital status categories used in this report are

married (persons legally married, 95.8 percent of the

category; and cohabitating persons, 4.2 percent of the

category), single, widowed, d]vorcedheparated (persons with legal divorces or separations), and unknown.

Ownership refers to the legal ownership status of the

establishment. Private nonprofit hospitals may belong

to mutual funds, retirement funds, nonprofit associations, and the like. Public hospitals are responsible to

the !Wate, but usually have their own management

structures and budgetary autonomy. Private for-profit

hospitals are owned by doctors and other investors

and are operated for profit.

The population estimate used to compute rates of discharges and days of care in this report is the population

residing in metropolitan France (which excludes overseas territories) at midyear 1981 or born during 1981

(table 1). The population is estimated by Institut National de la Statistique et des Etudes Economiques

(INSEE).

Data in this report are for short-stay hospital services,

which are defined by discipline. Medicine and medical

specialties, surgery and surgical specialties, and maternity are considered short-stay disciplines and are included regardless of the type of hospital establishment

in which they are found.

The source of payment in France is the means of

protection or insurance available to the hospitalized

individual: obligatory health insurance from the Social

Security system, which covers 80-100 percent of the

cost of hospitalization, and complementary coverage,

which in general is voluntary, a mutual or private

insurance fund covering all or part of the portion of

the hospitalization charges left to the individual. Medical assistance may ultimately cover the costs of hospitalizations of persons with very low income if they

are not covered by the Social Security system or if

out-of-pocket expenses are too high.

79
Term United States France

Source of their State’s definition of “low income. ” Workmen’s

payment Compensation is a government program in all States,

(continued) under which employees injured on the job receive financial compensation without regard to fault. The self-pay

category consists of patients who expect the costs of

hospitalization to be paid for primarily by themselves,

spouses, parents, or next of kin. Other sources include

other government programs, such as CHAMPUS (for

dependents of military personnel), other nonprofit

sources, such as church welfare, and hospitalizations

for which there were no charges.

80

*U.S. Government PRINTING OFF ICE: 19B8-2AI -2 S9:SI1OO5
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

-.. ,- .. ..- . -——---

rrograms ano Loliecnon rroceauree-HeportS ctescrmlng the

general programs of the National Center for Health Statistics

and its offices and divisions and the data collection methods

used. They also include definitions and other material necessary

for understanding the data.

Data Evaluation and Methods Researc&Studies of new statistical methodology including experimental tests of new survey

methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. Studies also include

comparison of U.S. methodology with those of other countries.

Analytical and Epidemiological Studies-Reports presenting

analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of

reports in the other series.

Documents and Committee Report+Final reports of major

committees concerned with vital and health statistics and documents such as recommended model vital registration laws and

revised birth and death certificates.

Comparative International Vital and Health Statiatica Reporte-Analytical and descriptive reports comparing U.S. vital

and health statistics with those of other countries.

Data From the National Health Interview Survey-Statistics

on illness, accidental injuries, disability, use of hospital, medical,

dental, and other services, and other health-related topics, all

based on data collected in the continuing national household

interview survey.

Data From the National Health Examination Survey and the

National Health and Nutrition Examination Survey-Data from

direct examination, testing, and measurement of national samples

of the civilian noninstitutionalized population provide the basis

for (1) estimates of the medically defined prevalence of specific

diseasea in tha United States and the distributions of the population

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons.

Data From the Institutionafized Population Surveye-Discontinued in 1975. Reports from these surveys are included in Series

13.

Data on Health Resources Utifizafion-Statistics on the ufilizatlon of health manpower and facilities providing long-term care,

ambulatory care, hospital care, and family planning services.

Skl-fl&i 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

Data on Health Resources: Manpower and Facifitiee-Statlst!cs on the numbers, geographic distribution, and characteristics

of health resources including physicians, dentists, nurses, other

health occupations, hospitals, nursing homes, and outpatient facil]-

fies.

Data From Special Surveys-Statistics on health and healthrek?ted topics collected m special surveys that are not a parl

of the continuing data systems of the National Center for Health

Statistics.

Data on Mortaliiy-Vanous statistics on morfahty other than

as included in regular annual or monthly reports. Special analyses

by cause of death, age, and other demographic variables; geographic and time series analyses; and statistics on characterisbcs

of deaths not available from the vital records based on sample

surveys of those records.

Data on Nataliiy, Marriage, and Divorc%Varlous statmt!cs

on natality, marriage, and divorce other than as included m regular

annual or monthly reports. Special analyses by demographic

variables; geographic and time series analyses: studlas of fertihty:

and statistics on characteristics of births not available from the

vital records based on sample surveys of those records.

Data From the National Mortafity and Natafity Surveye-Dlscontinued in 1975. Reports from these sample surveys based

on vital records are included m Series 20 and 21, respectively.

Data From the National Survey of Family Growtf+Stat@lcs

on fertility, family formation and dissolution, family planning. and

related maternal and infant health topics derived from a penodlc

survey of a nationwide probability sample of women 15-44 years

of age.

For answers to questions about this repori or for a list of titles of reports

published in these series, contact:

%ientifiC and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

Hyaftsville, Md. 20782

301-436-8500
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

3700 East-West Highway

Hyatkville, Maryland 20782

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DHHS Publication No. (PHS) 89–1480, Series 5, No. 4