By Cynthia Ayris Kemp
April 2, 2020
“In the state of Rhode Island, we do not have enough hospital beds. That’s a fact. That’s a brutal fact, it’s a fact.” Gov. Gina Raimondo
Let me say upfront – I am neither an expert on COVID-19 nor the hospital industry, but I am curious. As I read the abundance of stories about the novel coronavirus pandemic’s threat to health systems, my mind wanders back to Professor Stephen Coussens’ health economics class last year.[1] Acknowledging my nerd side, I confess that I’ve been rereading my class notes on the changes in the hospital marketplace. Specifically, I have wondered how the shedding of hospital beds over the last few decades has impacted our country’s preparedness for the pandemic.
Community hospitals (nonfederal hospitals providing short-term care) comprise over 85 percent of all hospitals. Between 1975 and 2020, the number of community hospitals and beds dropped 12% and 16%, respectively – a shedding of 150,000 beds throughout the country.[2] The economic forces of supply and demand explain the reduction in capacity. Dramatic increases in outpatient services, improved surgical procedures, and more effective pharmaceuticals decreased demand for hospital beds. Hospital closures due to financial distress or industry consolidation through mergers and acquisitions decreased supply.
How does this loss of hospital beds affect the United States’ preparedness for the COVID-19 pandemic? The density of hospital beds is one available metric to answer that question. Germany, which has a low case fatality rate due to widespread testing, is best equipped with 8.1 beds per 1,000 people.[3] In contrast, the U.S. has 2.8 beds per thousand.[4] Doing the math, the missing 150,000 beds would align the U.S. closer to Italy’s 3.2 beds per 1,000 persons – so better, but probably not sufficient.
Of course, there is a deceptive nature to averages as these statistics fail to convey the unequal distribution of capacity across a geographic region. For example, in my home state of Florida, there are 2.7 hospital beds per 1,000 of the state’s 21 million residents.[5] But fourteen of the state’s 67 counties have less than 50 beds within their county lines, collectively representing only 1.0 beds per 1,000 people. Another eight counties lack any hospitals at all. The fact that the novel coronavirus respects no geographic boundaries means that the preparedness will vary significantly across regions.
With the looming threat of an influx of patients, governments and health systems are devising innovative plans for additional beds. This week an emergency field hospital is opening in Central Park, close to here I spent much leisure time last year. The USNS Comfort, a U.S. Navy hospital ship, is being deployed to New York City, while its sister ship, the USNS Mercy heads to Los Angeles. Temporary hospitals are being constructed or planned on soccer fields and in arenas. Thankfully, lives will be saved by these innovative and heroic efforts to expand capacity.
I do wonder how the COVID-19 pandemic will change our thinking about hospitals of the future. Should the discussion focus on the optimal capacity of critical care hospital beds? What will we learn from innovative care models created from necessity during the pandemic? Should we build capacity of emergency field hospitals that can be deployed as needed? How can architects reimagine hospital spaces with adaptability and multi-purposes built into their designs?
One day this historic pandemic will end. I trust that lessons learned from COVID-19 – such the need for rapid and widespread testing – will be implemented to prevent the diffuse spreading that predicates the need for expanded hospital capacity. But certainly, the future holds future crises created by nature or man – it’s the proverbial “not a question of if, but when.” Hopefully not soon.
[1] Stephen Coussens in an Assistant Professor of Health Policy and Management at Columbia University Mailman School of Public Health.
[2] Compiled using data from the American Hospital Association website (www.aha.org)
[3] “The U.S. Has Fewer Physicians and Hospital Beds Per Capita Than Italy and Other Countries Overwhelmed by COVID-19.” The Henry J. Kaiser Family Foundation, 27 Mar. 2020, www.kff.org/health-costs/press-release/the-u-s-has-fewer-physicians-and-hospital-beds-per-capita-than-italy-and-other-countries-overwhelmed-by-covid-19/.
[4] Ibid.
[5] Compiled using data from the Florida Hospital Association website (www.fha.org) and Statista website (www.statista.com)