Hospital at home: What is its place in the health system?

Given the expansion of hospital at home in Western countries, policymakers, providers and financial managers are exploring the causes for this and examining whether hospital at home is an alternative to hospitalization for reasons of cost containment and quality of care. The purpose of this paper is to describe hospital at home, discuss its development and examine its role in the health system. A variety of models of hospital at home exist, serving a varied patient case-mix. This article claims that the reasons for the expansion of medical home care are not solely economic. Although a number of studies have examined the cost effectiveness of this service, no consensus has been reached. In fact, the growth of this service seems to be related to a number of other factors: the increase in the number of elderly and chronically ill people, the lack of availability and accessibility of acute and sub-acute inpatient services, technological innovation, improvements in the standard of living and the preference of some patients to be treated at home. Therefore, hospital at home must be examined, not as an independent service, but as part of a continuum of services, with the hospital system at one end and community services at the other end. Further research will help determine its optimal place along this continuum.