Global inpatient utilization from 1990 to 2020: effects of the COVID-19 pandemic

Abstract Background Inpatient service utilization rate is a key indicator for estimating the performance of health care systems on global, regional, and national levels. Methods We collected 1378 source-years of data, including administrative sources, nationally representative surveys, and government reports covering 130 countries overall, 29 of which are in the European region from 1990 to 2020. Inpatient admission was defined as an overnight stay at a formal healthcare facility for any cause. The data underwent age- and sex-splitting as per the available level of detail; survey sources were crosswalked to the gold-standard administrative data. The resulting data set was analyzed using Spatiotemporal Gaussian Process Regression (ST-GPR), a Bayesian meta-regression tool, to model the inpatient admission rate per capita across all countries, age groups, and sexes from 1990 to 2020. Admission rates were age- and sex-standardized to compute global proportions of hospitalized persons. Results In 2019, the global age-standardized inpatient utilization rate was 0.12 (95% uncertainty interval [UI] 0.09-0.15) admissions per capita. Globally, 0.93 billion (0.72-1.18) inpatient admissions were provided in 2019 compared to 0.68 billion (0.53-0.87) in 1990. In 2020, the global age-standardized inpatient utilization rate dropped to 0.057 (0.055-0.059) with a global proportion of hospitalized patients of 0.45 billion (0.43-0.46). Conclusions The increase in inpatient utilization from 1990 to 2019 may be attributable to population growth and increased capacity of health systems across most WHO regions. Health care utilization was highly variable between regions that was partly explainable by the variation in the socio-demographic index (SDI). The pandemic-mitigating measures limiting transportation and healthcare access were associated with the reduction in utilization in 2020. Key messages • The inpatient utilization rates were rising globally with large variation across regions, while decreasing in 2020 due the COVID-19 pandemic-related mitigating measures. • Health systems may use the inpatient utilization estimates to assess the effectiveness of health care reforms, plan for future capacity, and to allocate financial and human resources appropriately.