Does U.S. hospital capacity need to be expanded?

Health Affairs

Volumn 22, Issue 6, 2003, Pages 40-54

  Bazzoli, Gloria J ^a   Brewster, Linda R ^b   Liu, Gigi ^b   Kuo, Sylvia ^c  

^a VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^b CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^c MATHEMATICA POLICY RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMMUNITY HOSPITAL; ECONOMICS; EMERGENCY HEALTH SERVICE; EPIDEMIOLOGY; FACTORIAL ANALYSIS; HEALTH SERVICE; HOSPITAL BED CAPACITY; HOSPITAL DEPARTMENT; HOSPITALIZATION; HUMAN; ORGANIZATION AND MANAGEMENT; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

EFFICIENCY, ORGANIZATIONAL; EMERGENCY SERVICE, HOSPITAL; FACTOR ANALYSIS, STATISTICAL; HEALTH CARE SURVEYS; HEALTH SERVICES NEEDS AND DEMAND; HOSPITAL BED CAPACITY; HOSPITAL DEPARTMENTS; HOSPITALIZATION; HOSPITALS, COMMUNITY; HUMANS; UNITED STATES; UTILIZATION REVIEW;

EID: 1542539994     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.6.40     Document Type: Article

References (41)

1. B. Kirchheimer, "Full House: After Years of Decline, Inpatient Admissions Are Rising, Pushing New Construction," Modern Healthcare (26 November 2001): 28-31;
2. American Hospital Association, "Forces Driving Inpatient Utilization," Trendwatch (November 2001);
3. N. Petersen, "Hospital: Demand Outpacing Services," Philadelphia Inquirer, 6 November 2001;
4. "Overflow in Many U.S. Hospitals, Study Finds," Los Angeles Times, 9 April 2002;
5. and R. Abelson, "Patients Surge and Hospitals Hunt for Beds," New York Times, 28 March 2002.
6. California HealthCare Foundation, "Emergency Departments in the Health Care System: Use of Services in California and the United States," Issue Brief (Oakland, Calif.: CHCF, November 2002);
7. P. Neurath, "Emergency Boom: Hospitals Pinched by Escalating ER Visits," Puget Sound Business Journal, 5 August 2002;
8. "Harborview ER Project to Relieve Crowding," Seattle-Post Intelligencer, 10 April 2002;
9. S. Patrick, "Study Shows More ERs Diverting Patients," Dallas Business Journal, 17 September 2001;
10. S. Burke, "ER Traffic at Hospitals Increasing," Nashville Tennessean, 4 March 2002;
11. and N. Shute and M.B. Marcus, "Code Blue Crisis in the ER: Turning Away Patients, Long Delays, a Surefire Recipe for Disaster," U.S. News and World Report, 10 September 2001.
12. U.S. General Accounting Office, Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities, Pub. no. GAO-03-460 (Washington: GAO, March 2003);
13. L.R. Brewster, L.S. Rudell, and C.S. Lesser, "Emergency Room Diversions: A Symptom of Hospitals under Stress," Issue Brief Findings no. 38 (Washington: Center for Studying Health System Change, May 2001);
14. and S. Brown, "AHA: ED Diversions Point to Systemic Problems Not Readiness Inadequacy," AHA News, 22 October 2001.
15. Health Care Advisory Board, "The New Economics of Care: Briefing for the Board and Health System Executives" (Washington: Advisory Board Company, Fall 2001).
16. B. Japsen, "Hospital Capacity Debate Heats Up: Aging Population Means Sharp Rise in Need, Study Says," Chicago Tribune, 17 July 2003.
17. L.V. Green, "How Many Hospital Beds?" Inquiry (Winter 2002/2003): 400-412.
18. As defined by the AHA, staffed beds include only those that are available for patient care (set up and staffed). This measure is not the same as a hospital's licensed bed capacity, which relates to the maximum beds that a hospital can operate. Of course, the meaning of "staffed beds" is left to hospitals' interpretation and can vary considerably across hospitals and over time.
19. The deficiencies of using occupancy rates to measure the extent of use of hospital inpatient capacity are well known and have been discussed in several forums. They include lack of consideration of the type of hospital bed that is available versus needed at a point in time, the length of time patients wait until a needed bed becomes available, and the use of hospital inpatient beds for observation of patients receiving outpatient procedures.
20. J. Feder, J. Hadley, and S. Zuckerman, "How Did Medicare's Prospective Payment System Affect Hospitals?" New England Journal of Medicine (1 October 1987): 867-873;
21. and J. Hadley, S. Zuckerman, and J. Feder, "Profits and Fiscal Pressure in the Prospective Payment System: Their Impacts on Hospitals," Inquiry (Fall 1989): 354-365.
22. C. Worzala, N. Zhang, and G.F. Anderson, "The Effect of HMOs on Hospital Capacity, 1982-1996," Managed Care Interface (February 2000): 51-61;
23. J. Ashby, S. Guterman, and T. Greene, "An Analysis of Hospital Productivity and Product Change," Health Affairs (Sep/Oct 2000): 197-205;
24. and M.D. Rosko, "Impact of HMO Penetration and Other Environmental Factors on Hospital X-Inefficiency," Medical Care Research and Review (December 2001): 430-454.
25. In the simplest case, an increase in prices would clear a market with excess demand, but in health care, prices may adjust slowly given Medicare fixed prices and multiyear private-sector contacts. Further, even if prices could increase, hospitals may not be able to increase supply because of regulation affecting capital inputs (such as certificate-of-need requirements) or existing labor shortages. In addition, health markets are plagued with a variety of additional problems (such as imperfect information and the effects of moral hazard) that could lead to mismatch in the optimal supply and demand for health services. See C.W. Madden, "Excess Capacity: Market Regulations and Values," Health Services Research (February 1999): 1651-1668;
26. and B. Friedman, "Excess Capacity: A Commentary on Markets, Regulation, and Values," Health Services Research (February 1999): 1669-1682.
27. See C.S. Lesser and P.B. Ginsburg, "Guest Editors Introduction: Community Tracking," Health Services Research (February 2003, Part II): 333-336.
28. Brewster et al., "Emergency Room Diversions";
29. and K.J. Devers et al., "Hospitals' Negotiating Leverage with Health Plans: How and Why Has It Changed?" Health Services Research (February 2003, Part II): 419-446.
30. In fact, the response rate to the on-site surveys was roughly 82 percent.
31. All interview notes were stored and analyzed through Atlas.ti, a computer software package designed to support qualitative research.
32. Devers et al., "Hospitals' Negotiating Leverage with Health Plans."
33. These differences were apparent even if one looked at older AHA Annual Survey data in relation to hospital occupancy rates. For example, occupancy rates for community hospitals in the Boston MSA ranged from 33 percent to 98 percent in 2001.
34. L.H. Aiken et al., "Nurses' Reports on Hospital Care in Five Countries," Health Affairs (May/June 2001): 43-53.
35. B.C. Strunk and P.B. Ginsburg, "Aging Plays Limited Role in Increasing Health Care Cost Trends," Data Bulletin no. 23 (Washington: HSC, September 2002).
36. InterStudy, "HMO Enrollment Stabilizing, Medicaid Continues to Grow: InterStudy Releases Updated HMO Industry Report" (St. Paul, Minn.: InterStudy, 7 May 2002);
37. and A.C. Enthoven and S.J. Singer, "Unrealistic Expectations Born of Defective Institutions," Journal of Health Politics, Policy and Law (October 1999): 931-940.
38. Health Resources and Services Administration, "Findings from the National Sample Survey of Registered Nurses," Pub. no. BHP00168 (Washington: HRSA, 22 February 2002).
39. Centers for Medicare and Medicaid Services, "Health Care Industry Market Update: Acute Care Hospitals," 14 July 2003, www.cms.gov/reports/ hcimu/hcimu_07142003.pdf (12 August 2003).
40. Brewster et al., "Emergency Room Diversions."
41. CMS, "Health Care Industry Update."