Writing in the Wall Street Journal, a cardiologist argues that America has a shortage of hospital beds and it’s turning into a crisis. Purportedly, the United States has only three (3) hospital beds per 1,000 population. The European Union has five (5), while Japan was 13. That sounds like a huge disparity but direct comparisons of hospital beds per capita does not tell us much. Different countries use hospital beds for different purposes. For the past 40 years the U.S. has been emphasizing shorter, more intense lengths of stay. Once stable, patients are moved out of hospital beds to skilled nursing facilities, long term acute care hospitals and nursing homes. From there they often go home, with home care. By contrast Europe to some degree and Japan to a significant degree use hospitals as a place to warehouse patients while they recuperate. The British National Health Service even has the term, bed blocker. Hospitals are expensive places, where patients often require surgery, chemotherapy, or other expensive care. A bed blocker is a patient allowed to convalesce in a hospital bed to avoid admitting someone new who needs more expensive care.
Japanese hospitals often combine the services of hospitals, skilled nursing, nursing homes, etc. The average length of stay in an American hospital is 4.5 to 5.7 days. European hospitals have an average length of stay of 7.5, while Hungarian patients average about 10 days. In Japan, the average length of stay for patients with acute care needs is about 16 days. When nursing home patients are included in total then the average length of stay for all hospitalized patients rises to 26 days.
Occupancy rate in U.S. hospitals is 75%. The writer is concerned that the current number will not be enough capacity to provide inpatient care for 70 million aging Baby Boomers.
Experts warn that 85% occupancy is a critical threshold at which hospitals may cease to function properly because of overcrowding and staffing shortages that can result in medication errors and other deadly mistakes. A recent study suggests that this threshold may be reached in the U.S. within 10 years, potentially resulting in tens or even hundreds of thousands of excess patient deaths annually.
The writer goes on to explain that part of the reason for a shortage of hospital beds is certificate of need laws (CON), that essentially requires permission to build new hospitals. Proponents of CON laws believe that hospital beds tend to be filled, even unnecessary ones. Therefore, it saves money to limit hospital beds. The reality is that CON laws drive prices up by limiting competition. These laws should be repealed, and many states are doing so.
Whether there is currently a shortage of hospital beds is debatable. There is certainly a mismatch where hospitals are located and where they are needed. My fast-growing suburban neighborhood has numerous new hospital buildings with more going up every year. By contrast, urban and rural areas face a dearth of hospital beds, with hospitals closing every year. The reason has to do with reimbursement. Urban areas, and small towns outside major cities, often have far fewer people with private health insurance and a significant percentage of patients on Medicaid or Medicare. Doctors do not want to live in small towns, and many do not want to practice in urban areas far from where they live. The same workload could result in only a fraction of the income for physicians working where most patients have government insurance.
Some potential ways to boost hospital capacity is telemedicine where physicians hundreds of miles away can treat rural patients. In addition, some areas are experimenting with hospital-at-home. That is where a patient is officially in the hospital, but care is provided in their own home with remote monitoring and home care.
The current paradigm of sick patients going to the hospital is becoming unsustainable. Current attempts to reduce the cost of hospital care is a Gordian knot of convoluted care provided at different prices in diverse types of facilities. The shortage of hospital beds is unlikely to improve until health care reform creates incentives for facilities to compete to make care more efficient and more affordable. The current system of moving patients around to maximize reimbursement or minimize cost has more to do with bureaucracy than competition.
Read more at WSJ: America’s Hospital-Bed Shortage Is About to Become a Crisis