A comparative review of gynecological day case surgery between England and Wales, France, and Germany.

A comparison was made of gynecological day case surgery between England and Wales, France, and Germany. Hospital In-Patient Enquiry statistics (1979-1985) as well as Department of Health statistics (after 1985) and the Audit Commission Reports (1990-1992) were used for England and Wales; the Baudelocque Hospital Audit (Paris) between 1985 and 1990 was used for France; the Niedersachsen Regional Audit between 1989 and 1990 was used for Germany. These are the only available statistics for all three countries. A retrospective analysis of these statistics of gynecological day case surgery produced estimates of its rate for common gynecological operations in the three countries. It showed that England and Wales performed significantly more (18 per cent) gynecological procedures as day cases than either France (less than 5 per cent) or Germany (11 per cent). Additional specific comparisons were made for certain procedures between England and Wales and France (TOP) and between England and Wales and Germany (D&C, laparoscopy, TOP, ERPC, and cone biopsy). day case surgery was performed in hospitals in England and Wales and in France whereas it was performed in freestanding units in specialists surgeries in Germany. Furthermore, there seemed to be a wide regional variation in the rate in England and Wales and in Germany. Waiting lists were significant in England and Wales and nonexistent in France and in Germany. However, medical unemployment was almost nonexistent in England and Wales whereas it was alarming in France and in Germany. The methods of financing of the health care systems appear to explain the intercountry variation.