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The cottage hospital model may be defined as an intermediary service between primary care and the general hospital. On the basis of experience and studies from Finnmark county, the northern-most county in Norway, this article makes a case for a revival of the cottage hospitals. They may improve comprehensive patient care and cooperation between care levels, to the benefit of groups of patients who often are in a squeeze between care levels: the elderly, the chronically ill, and the severely ill and dying patients. The cottage hospitals may also contribute to strengthening the chain of service in acute medicine. The professional challenges of work in a cottage hospital may attract practitioners to primary health care. We suggest that 1% of the funds set aside for ongoing national programmes for the elderly, in cancer care and mental illnesses are used for cottage hospital beds, as this may contribute to increasing the viability of these programmes. The extra cost upgrading 1,000 of a total of 27,000 nursing home beds in Norway to cottage hospital standard is estimated to be modest.

An analysis was made of 414 admissions during a one-year period to three general practitioner beds. Within the first day, 20% of the patients were discharged, while 22% were transferred to the main hospital after examination and primary treatment. 58% stayed more than one day. The mean stay was 5.0 days. The three major groups of medical conditions according to the International Classification of Primary Care were cardiovascular diseases, diseases of the musculoskeletal system and diseases of the lungs and the respiratory tract. Patients > or = 60 years of age constituted 55.8% of the total, taking up 80.6% of total bed days. In the age group > or = 80 years of age, there were three admissions for every five inhabitants, while two in five had one or more hospital stay. 65% of all patients (15.7%) had two stays or more, taking up a total of 60.5% of total bed days. Using the general practitioner beds as a low threshold service proved especially useful with patients suffering from heart failure, asthma or chronic obstructive lung disease. The beds had a key function in the rehabilitation of the elderly, in the care of cancer patients, and in terminal care. They were of basic importance to the organisation of daily emergencies.