1/23/17

Few hospital beds & sparse hospital staff means overflowing hospitals

There's a lot of news stories of late about hospitals overflowing with too many inpatients and not enough beds. Here's some of the headlines:


 


 


 

What is not so often reported is that this is directly related to Ontario's policies of very high hospital bed occupancy and very few hospital beds.

The graph below shows curative hospital bed occupancy in European countries -- with occupancy levels usually hovering around 75%. The exceptions are Ireland (which has well above average occupancy) and Macedonia and the Netherlands (which have well below average occupancy). Between 2008 and 2014 most countries saw a small decline in bed occupancy. 

European hospital bed occupancy
Under the OECD definition, "curative" hospital beds excludes rehabilitative and long term care beds.  Eurostat, “Health care resource statistics – beds,”  2016, http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_resource_statistics_-_beds
Ontario however often has hospitals with bed occupancy over 90% in all sorts of hospital beds -- chronic care, rehabilitation, acute care, mental health care. It is not specially unusual for larger urban centres to have occupancy over 100%, and sometimes far over 100%.

Since 1990, Ontario has eliminated 19,000 hospital beds (and 30,000 beds since 1980). The result is that Ontario is now an extreme outlier in terms of the number of hospital beds. Directly connected with this, the rest of Canada has about 22% more hospital staff than Ontario. 
hospital staffing in Canada The OECD, the club of rich nations, reports the number of beds per thousand for its thirty-four members.  The  average (excluding Canada) for the most recent year reported is 4.9 hospital beds per 1,000 population (see chart below). 

Ontario has about 2.2 hospital beds per 1,000 population, well less than half the average number in other developed nations. 

So it is hardly surprising that Ontario hospitals often have extremely high bed occupancy rates.  Given the  limited number of beds, it is a great credit to the efficiency of Ontario hospitals that overflows do not occur more frequently.

Notably, the Ontario Hospital Association  claimed this week that "in November, recognizing the need to open more beds and address wait times in hospitals, the Ontario government provided an additional $140 million for hospital services."

For years, the government has simply ignored or blithely dismissed the need for more hospital beds. So this is, perhaps, an interesting, if very modest, turn to the good. 

 hospital beds per 1000 population OECD