As the costliness of the acute hospital sector is of critical importance to the demands on the health sector as a whole, this paper presents an assessment of the trends in expenditure and utilization of this service area for selected OECD countries since the early 1980's. This analysis shows that despite reductions in bed availability and lengths of stay, admission rates and expenditures have generally been increasing over the period. As the continuing rise in expenditure levels is cause for growing concern at the individual country level, the reform of the financing of the acute hospital sector has become a more urgent priority.