This policy brief is intended for policy-makers and others addressing the issue of hospitalsand their role in health care systems.The European Observatory on Health Systems and Policies is a partnership between the World HealthOrganization Regional Office for Europe, the Government of Belgium, the Government of Finland, theGovernment of Greece, the Government of Norway, the Government of Spain, the Government ofSweden, the European Investment Bank, the Open Society Institute, the World Bank, the LondonSchool of Economics and Political Science, and the London School of Hygiene & Tropical Medicine.www.observatory.dkWHO Regional Office for EuropeScherfigsvej 8, DK-2100 Copenhagen ØDenmarkTel.: 45 39 17 17 17Fax: 45 39 17 18 18E-mail: observatory@who.dkThe European Observatoryon Health Systems and PoliciesEuropeanObservatoryEuropeanon Health Systems and PoliciesObservatoryon Health Systems and PoliciesReducinghospital bedsWhat are the lessonsto be learned?byProfessorMartin McKeeNo. 6 · 2004
EuropeanObservatoryon Health Systems and PoliciesPolicy brief no. 6Martin McKeeReducing hospital beds:what are the lessons to be learned?What is meant by hospital bed capacity?Adapted from a synthesis report prepared for theHealth Evidence Network (HEN), 2003 (1)This misleadingly simple question raisesmany further questions. First, what is a hospital bed? This seemingly straightforward question is actually almost impossible to answer.Though hospital bed numbers are frequentlyused as a measure of the capacity of a healthcare system, a bed is merely an item of furniture on which a patient can lie. For a bed tomake any meaningful contribution to a healthcare facility’s ability to treat someone, it mustbe accompanied by an appropriate hospitalinfrastructure, including trained professionaland managerial staff, equipment and pharmaceuticals. Furthermore, there are many different types of hospital bed, reflecting differences in the kind of patient they are designed toaccommodate. A bed for a patient undergoingrehabilitation after a stroke is very differentfrom a bed for a patient with multiple organfailure, who requires ventilation, dialysis andcirculatory support. To complicate the matter, there are many pieces of furniture withinhospitals that appear to be beds but are not included in hospital bed numbers. They includebeds for patients’ relatives (frequently accompanaying children), cots for normal newbornFor many people, the hospital has come tosymbolize the modern health care system.Yet in many countries, the role of the acutehospital is changing, with an emphasis onoutpatient diagnosis and treatment as well asalternatives to long-term hospital care, leading to reductions in numbers of hospitalbeds. International comparisons that showlarge variations in hospital bed numbers,combined with the knowledge that hospitalsare relatively expensive, often create political pressure to reduce hospital capacities. Asa result, there is considerable interest in howcountries that have reduced hospital capacityhave done so, and what impact such changeshave had on different stakeholders.This policy brief looks at how hospitalbed capacity has changed in Europe duringthe past decade and at possible explanationsfor these changes. However, it is first necessary to consider briefly some underlying issues.Policy brief no. 61Reducing hospital beds
Which European countries have reduced hospital bed capacity most?infants and beds for patients having ambulatory surgery. Similarly, there are some itemsof furniture that do not appear to be beds butmay be counted as such, including chairs inwhich patients undergo dialysis.Second, what is a hospital? This questionaddresses the nature of the interface betweenhealth care and social care. Traditionally, manyso-called acute hospitals have provided longterm nursing care for significant numbers ofpatients. While many of these patients are nowcared for in alternative facilities, such as nursing homes, the level of alternative care provided by different countries varies substantially and is unrelated to the age structure of theirrespective populations.(2) In some countries,facilities once labelled hospitals have been redesignated nursing facilities, as happened inBelgium in 1982.(3) Such changes affect theaccuracy of comparing bed numbers overtime (are apparent reductions simply redesignations?) and among countries (are the sametypes of facilities included?).Because of the problems created by theshifting interface between hospital and social care, this policy brief will concentrate onwhat are commonly referred to as acute hospital beds. There also exists an extensive specialist literature on reductions in long-termpsychiatric beds that could be the subject ofa policy brief in its own right.It should be noted that, even when usingthis more restricted definition, international comparisons are still fraught with problems, reflecting differences in how hospitalcare is organized in different countries. AsTable 1 shows, countries vary considerablyin what they include in the acute bed numbers they report to international organizations. In particular, some countries excludeentire sectors, such as private, military orprison health care, from their statistics.Policy brief no. 6Clearly, when answering this question, themany caveats noted above must be bornein mind. However, figures reported to theWorld Health Organization show that, since1990, hospital bed numbers in some countries have fallen dramatically (see Fig. 1, page4).In absolute terms, the greatest reductionsoccurred in some of the countries that hadthe largest concentrations of beds in 1990.These countries include former republicsof the Union of Soviet Socialist Republics(USSR), particularly those in the Caucasusand central Asia that faced the greatest economic hardships during the 1990s. However, in relative terms, large changes also occurred in Finland and Sweden (47% and45%, respectively). Most of the other countries in western Europe experienced reductions of between 10% and 20%. Of course,these figures only measure one aspect of hospital activity; some countries, such as theNetherlands, made only small reductions inbed numbers while making large reductionsin bed occupancy. A more detailed analysis ofinternational trends in hospital activity fromthe mid-1980s to the mid-1990s was undertaken by Hensher, Edwards and Stokes (6).Were these changes the result ofhealth care reforms?Once again, this question raises another one.Even if closures were a result of health carereform, was bed reduction the aim of the reform, or was it an unintended consequence?Or did it occur for other reasons?As ever, the situation varies. In both Swedenand Finland, a substantial part of the reductions can be attributed to decisions to transfer parts of the health care system to the social2Reducing hospital beds
Table 1. Definition of acute hospital beds in selected countriesCountryDay care bedsincluded?Type of beds includedAustriaBeds in hospitals where average length of stay is 18 daysor lessBelgiumBeds in general hospitals that do not provide chronicdisease care, geriatric services or other specialty careCzech Republic All beds in general hospitals (including psychiatric beds)DenmarkBeds in hospitals, excluding departments with averagelengths of stay longer than 18 days (except for inpsychiatric hospitals, where all beds are counted)FinlandBeds in inpatient wards of general and specializedhospitals and health centresGermanyBeds other than psychiatric and long-term bedsIcelandInternal medicine and surgery beds in main hospitalsand beds in mixed facilities in small hospitals; numberscalculated from bed-days, assuming a 90% occupancy rateIrelandInpatient days and day beds in publicly funded acutehospitals, defined as hospitals where average length of stayis generally less than 30 days; includes voluntary (nonprofit-making) hospitals and health board hospitalsItalyIncludes inpatient beds in psychiatric hospitals and inpsychiatric wards of other hospitalsNetherlandsBeds in inpatient wards of hospitals with specializedservices, excluding psychiatric hospitals; includes cots fornormal neonates and day care bedsNorwayGeneral and specialized inpatient hospital bedsPortugalBeds in general hospitals, maternity hospitals, otherspecialized hospitals and health centresSpainBeds in general hospitals, maternity hospitals, otherspecialized hospitals and health centresSwedenBeds for short-term care in facilities run by countycouncils and independent communities, in whichshort-term care includes medical short-term, surgicalshort-term, miscellaneous medical/surgical, admissiondepartment and intensive careTurkeyBeds in public hospitals, health centres, maternityhospitals, cardiovascular and thoracic surgical centres andorthopaedic surgery hospitalsUnitedNational Health Service acute medical, surgical andKingdommaternity beds, excluding those in Northern esSource: Extracted from OECD health data 2003 (4) and national documents.Policy brief no. 63Reducing hospital beds
sector. In Sweden, this was the aim of the1992 Ädel Reform, in which the municipalities assumed responsibility for the care ofmany long-term patients.(7) It led to boththe redesignation of existing facilities anda programme to construct more appropriate long-term facilities outside the hospitalsector. However, simple comparisons of bedsin each sector can also be misleading, as theexample of Denmark shows. Construction ofnew nursing homes there stopped in 1987,and subsequent investment has focused onsheltered housing and social and nursingsupport to individuals living in their ownhomes.(8) As a consequence, bed reductionsin the Danish hospital sector have not beenaccompanied by bed increases in the socialsector, because care is now provided in dif-Fig. 1. Acute hospital beds per 100 000 population, 1990 and 2002 (or latestavailable year)KazakhstanRepublic of MoldovaUkraineRussian aCzech landDenmarkSwedenGreeceNetherlandsTFYR MacedoniaNorwayPortugalAlbaniaSpainIrelandUnited 00Source: European health for all database, WHO Regional Office for Europe, 2004 (5).Policy brief no. 64Reducing hospital beds
ferent ways. In England, a detailed analysisof changing patterns of hospital activity (9)identified many different contributing factors, in which a reduction in acute hospital stays was counterbalanced by a major expansion of beds in private nursing homes, sothat total bed numbers increased slightly.In Kazakhstan, by contrast, the reduction in beds was unplanned and largely aconsequence of the withdrawal of fundingfrom the republic’s many small rural hospitals. Three-quarters of these hospitals, whichwere underused and able to provide onlyvery basic health care, closed between 1991and 1997.(10)In Estonia, the reduction was also partlydue to the closure of small, poorly equippedhospitals, although in this case it was a resultof an explicit policy to introduce a system ofaccreditation, which these hospitals failed, in1994.(11) In the Republic of Moldova, localgovernments reconfigured many small hospitals as primary care facilities.(12) In Albania, change arose initially as a consequenceof the near collapse of the health care system during the widespread civil disorder ofthe early 1990s. The unrest led many healthcare workers to flee rural areas, where theyhad been working in small, dilapidated rural hospitals.(13) Subsequently, with assistance from a large World Bank loan, many ofthese facilities were closed and others wereconverted to primary care facilities. However, further progress since 1994 has beenslow, in part because it has been impossibleto achieve consensus on which Albanian facilities to invest in and which to close.A further question arises when considering the impact of reforms on bed closures.Have the reforms that have sought to reducebed capacity succeeded, and if not, why not?The answer is rather mixed. Some west-Policy brief no. 6ern European countries have been too successful in reducing acute bed numbers andnow find that they face shortages. For example, Ireland (14), Denmark, the United Kingdom (15) and Australia (16) have all facedgrowing waiting lists or other difficultiesin admitting acutely ill patients to hospital,and they are now attempting to expand bednumbers. The situation in the United Kingdom is complicated, not least because ofthe different approaches in each of the fourconstituent countries (England, Scotland,Wales and Northern Ireland). Expansion wasthreatened by the introduction of a new system for financing capital developments, inwhich higher costs meant that new hospitalswere smaller than the ones they were replacing (17), while hoped-for improvements inefficiency (measured as patient throughput)were not being realized (18).This difficulty isbeing addressed in England by the creationof new, stand-alone facilities for non-urgentsurgery.Elsewhere, change has been more difficultto achieve. A review of experiences in western Europe (19) found that achieving reductions in capacity (whether measured in bedsor hospitals) was most difficult where facilities were owned and managed by differentorganizations. The move towards greater autonomy for hospitals seen in many countriescan be expected to make change difficult, asthe institution’s interests take precedence ofthe wider health system’s. Change was mostlikely to succeed in countries like France(20) and Spain (21), where health care delivery was considered from a regional perspective, taking account of the overall pattern of hospitals and other health care facilities, and where change was accompanied bysustained investment in alternative facilities.In contrast, some countries in central and5Reducing hospital beds
eastern Europe with historically high levels of hospital provision have faced difficulty in reducing capacity. In Hungary, for example, a succession of reduction efforts hadonly limited success. They included the useof financial incentives based on diagnosis-related groups (DRGs), central designation ofbed-reduction targets for individual hospitals, and a regional initiative to develop substitutes for hospital care and increase hospital efficiency.(22) In Poland, where there wasvery little change in the number of beds until the late 1990s, a decrease of 13 033 acutebeds between 1998 and 2000 (5.6% of thetotal) was partly compensated for by an increase of 5200 long-term beds.(23) A reviewof experiences with hospital system restructuring in central and eastern Europe (24)identified a series of challenges that wererarely addressed adequately. These includeda failure to take account of the specific context within which reform was taking place,an over-reliance on market mechanisms tobring about change, insufficient recognitionof the wide range of stakeholders involved, afailure to ensure that incentives and policieswere aligned, and a lack of appropriate human resources to implement reforms.tine data, ideally on a population basis. Except in Scandinavia, few countries in Europehave such systems.Although the United States has been thesetting for much of the published researchon hospitals, Europe’s ability to draw lessons from the American experience is limited, except in certain narrowly defined areas such as the impact on health care staff, because much of the American research reflectsissues that arise from the particular characteristics of the market-oriented United Stateshealth care system. Consequently, from aEuropean perspective, the most importantsource of information is Canada, where notonly have there been major reductions inhospital capacity, but where, uniquely, thesechanges have also been studied in great detail.Before addressing the main question ofwhat lessons can be learned from countrieswhere acute hospital beds have been significantly reduced, it may be useful to reflectbriefly on two questions concerning theneed for hospital beds.How many beds are needed?This is probably the most frequently askedquestion about hospitals. It is also one thathas no easy answer, except that it depends ona variety of factors, some of which the healthcare system cannot easily change, such as thedisease patterns and social structure of thepopulation being served.(26) Other factorsare more easily altered, such as the efficiencyof diagnosis and treatment (27) and the provision of alternatives to hospital care (28).There are many models that seek to take account of these numerous factors.(29, 30, 31)These models can be valuable means to testdiffering assumptions, but they require extensive data that are often unavailable (32),The research evidenceDespite the importance of the hospital to thehealth care system, there is remarkably little published research on the reconfigurationof hospital systems, and most of what existsis from Canada or the United States. This reflects several factors. First, as has been notedelsewhere (25), the concentration of such research in a very few countries reflects in partthe willingness of funding agencies there tosupport organizational research in the healthsector. Second, evaluative research requireswell-developed systems for collecting rou-Policy brief no. 66Reducing hospital beds
and given the many complex feedback systems involved, prediction is difficult.tate earlier discharge. They require the creation of a wide range of alternatives to hospital care, including nursing homes and intensive interventions in the home. However, theauthors concluded that most interventionsintended as alternatives to hospital care actually complement it, so that the total volumeof activity increases. Furthermore, many interventions designed to support patients inthe community either are no cheaper or aremore expensive than hospital care.A Cochrane Review of the effectivenessof discharge planning (36) found some evidence that it may reduce the length of hospital stays, and may in some cases reduce readmissions. However, although few of thestudies had conducted formal economic analyses, there was no evidence that discharge planning reduced health care costs.Another review comparing hospital-athome schemes with conventional inpatient care (37) concluded that, while suchschemes can reduce the number of acutebed days, they prolonged the overall periodof care and provided no cost savings.A growing number of evaluations haveexamined packaged care in which patientswith common conditions are actively managed according to protocols, supported bysystem redesign to ensure coordinationamong the various inputs required.(38, 39)These packages do appear to reduce lengthsof stay or costs.What impact does an ageing population have on bed requirements?It is widely assumed that an ageing population will increase the need for acute hospitalbeds. This assumption may not be justified.Although ageing has led to increased utilization in many countries, the increase is largely attributable to growing numbers of people with chronic diseases, particularly cognitive decline, for which acute care is ineffective, while alternatives, especially nursing care, are more appropriate.(33) The wellknown relationship between age and theneed for acute care is actually a reflectionof the increase in need with proximity todeath, with individuals requiring the greatest resources in the year that they die. Consequently, the effects of an ageing populationare minor.(34)How can the need for hospital bedsbe reduced?The most effective, if difficult, way to reducethe need for hospital beds is to enhance thehealth of the population. In the short term,however, two broad categories of intervention may be effective: preventing admissionand facilitating rapid discharge. The evidenceconcerning the effectiveness of particular interventions has be
and beds in mixed facilities in small hospitals; numbers calculated from bed-days, assuming a 90% occupancy rate No Ireland Inpatient days and day beds in publicly funded acute hospitals, defi ned as hospitals where average length of stay is generally less than 30 days; includes voluntary (non-profi t-making) hospitals and health board .
growing in them, nursery beds are classified into seedling beds and transplant beds. Seedling beds are those nursery beds in which seedlings are raised either for transplanting in other beds or for planting out. A nursery which has only nursery beds, i.e., in which only seedlings are raised, no
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MO Hospital Profiles By Name Thursday, April 8, 2021 Total Fac Count Last updated 165 Barnes-Jewish Hospital One Barnes Jewish Hospital Plaza Med/Surg Beds: 677 LTC beds: 0 St. Louis, MO 63110 Pediatric Beds: 0 Administrator: Dr. John Lynch, President Phone: (314) 747-3000 Fax: (314) 362-0468 Facility ID: H006 ICU Beds: 173 Al
Alameda County Medical Center DSRIP Proposal. February 17, 2011. 6 The three hospital campuses include 236 acute care beds at Highland Hospital, Oakland, 50 acute rehabilitation beds and 109 skilled nursing facility beds at Fairmont Hospital, San Leandro, and 80 psychiatric beds at John George Psychiatric Pavillion in San Leandro.
Bangkok Hospital 25 4,222 Samitivej Hospital 6 1,364 Phyathai Hospital 5 1,241 Paolo Hospital 6 1,008 BNH Hospital 1 144 Royal Hospital 2 130 Local Hospital 4 627 * Maximum number of beds according to structure of the hospitals 49 Hospitals 8,700 Beds 11,000 Doctors 8,000 Nurses 24,000 Staffs 11 Centers of Excellence BDMS Wellness Clinic &
for bunk beds varies from 200 to 1,500. Families who purchase bunk beds tend to have less room, multiple children, or see bunk beds as a cost effective purchase. In addition to the retail market, bunk beds are also sold second hand, particularly online via trading and auction sites. Data collected by the ACCC in 2012 shows 18 per cent of .
Some include Yakima County, WA Department of Corrections (1200 beds), Dallas County, TX (8500 beds), Lake County, IN (1050 beds) St. Croix and Chippewa Counties, WI (500 beds combined) and Orange County, TX (350 beds)
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