A new report from the Dartmouth Atlas of Health Care finds that, overall, the hospital bed supply per capita contracted from 1996 to 2006, while the numbers of hospital-based employees and registered nurses increased.
The number of staffed acute care beds dropped from 2.82 per 1,000 U.S. residents in 1996 to 2.46 per 1,000 in 2006, according to the report. However, there was great regional variation. For example, the Jackson, Miss., area had 4.44 beds per 1,000 in 2006, compared with 1.45 in San Mateo County, Calif. Not surprisingly, the areas with the most beds also had high numbers of hospital employees.
“As long ago as the 1960s, Milton Roemer described the phenomenon that a built bed was a filled bed,” noted the report authors. “Numerous studies since then have found that higher bed supply is associated with more hospital use for conditions where outpatient care is a viable alternative. This includes most medical causes of hospitalization.”
Physician supply continued to expand “modestly,” although numbers varied greatly by specialty, the report said. For example, the number of primary care physicians increased 11% over the study period, compared with 51% for infectious disease specialists and a whopping 198% for critical care specialists. Specialties that experienced declines included cardiothoracic surgery (-17%), pulmonology (-18%), and general surgery (-19%).
The authors made several suggestions for managing hospital capacity and physician workforce growth. To reduce “unwarranted” variations in hospital supply, “Congress could require the Centers for Medicare and Medicaid Services to use its capital payment policies to limit the further growth of hospital capacity in markets that are already overinvested,” they wrote. “Although Certificate of Need programs have generally not been effective, strengthening [such] programs or statewide prospective hospital budgeting processes could be used to more wisely target future hospital growth. Neither of these approaches, however, would help reduce capacity in regions that already have an oversupply.”
To better adjust the physician workforce, “a national workforce commission with representation from the clinical professions, public health, health care purchasers, and patients would provide badly needed analyses and research to better direct funds for health workforce training and for provision of care to the underserved,” the authors suggested.
Another alternative for getting both hospital bed capacity and the physician workforce to the right size would be a more market-oriented approach based on organized systems of care, according to the report.
“Consensus is emerging that integrated delivery systems that provide strong clinical support to clinicians and team-based care management for patients offer great promise for improving quality and lowering costs,” the authors wrote.
“Hospital and Physician Capacity Update: A Brief Report from the Dartmouth Atlas of Health Care” is available at www.dartmouthatlas.org/atlases/Capacity_Report_2009.pdf