Hospital bed decreases were a precondition to the pandemic

Here’s a chilling statistic.

But there are important questions that are attracting little attention: Why does America not have enough hospital beds to deal with this emergency? Why does an increase in 155,000 patients, about 3,000 additional patients per state, push the system to its breaking point?

The answer is that there are far fewer hospital beds in the United States today than there were just a few decades ago. In 1975, when the United States had 113 million fewer people, there were 1.5 million hospital beds in the United States. Today, there are just over 900,000.

That seems backwards. Why would one of the richest countries in the world start stripping itself of healthcare facilities before the pandemic hit? Read the link, it goes on at length about the processes that led to a reduction in hospital services, in short:

Vertical and horizontal consolidation means there is little competition for hospitals and related services that hospitals also own. By 2016, “90 percent of all metropolitan areas had highly concentrated hospital markets.” The lack of competitors has allowed hospitals to raise prices for outpatient services “four times faster than what doctors charge.”

In other words, hospitals are getting rid of hospital beds because they are making more money diverting patients elsewhere. The focus on the bottom line applies both to for-profit and non-profit hospital networks, which operate nearly identically.

I can be even shorter: because capitalism. The purpose of hospitals is to make money for their owners, don’t you know.


  1. phoenix3 says

    It’s simple, the USA has a “for profit” health care system, whereas civilised countries have “for patient” healthcare systems



  2. jrkrideau says

    Canada is in a bit of the same fix but it is because most of the provinces, no matter which party is/was in power has consistently underfunded healthcare and that also includes training. IIRC federal transfers consistantly increased by X amount and provincial expenditures increased my X/2 and the provinces stashed the difference.

  3. says

    I’m going to gently suggest that this is not a complete explanation. Once upon a time, I worked in hospitals — during the period in which this consolidation began. And not so long afterward, I spent time there in, um, the “customer” role.

    At least part of this “loss of beds” is the evolution from open wards to shared rooms, and from shared rooms to private rooms, as the dominant means of providing “beds.” Some of this is privacy concerns; some of it, too, is a combination of effectiveness-of-care concerns (people heal faster and better when they’re not subjected to their “neighbor”‘s Uncle Bob’s guffaws) and better isolation of biologicals, ranging from airborne to dirty sheets. (Once you’ve actually changed a few beds for patients in the aftermath of a drunk driver’s inattentions, you’ll have more appreciation for that!)

    Then there’s all the additional equipment now required at hospitals. It’s not just that it’s expensive — it’s that setting up a modern radiology department with a pair of CT scanners and an MRI takes up the space for half a dozen or so beds.

    Finally, remember that an awful lot of procedures “done in hospital” that required a several-day-long hospital stay under standard conditions of care in the 1960s (all the way through the 1980s) are done now as essentially outpatient procedures. Some for bad, profit-related reasons; others because, to use one specific example, knee surgery is a lot less traumatic and intrusive now. One didn’t see Joe Athlete (and as late as the 1980s it wasn’t Jo) smiling and walking out to a car on the same day as surgery after repairing an ACL tear; one saw everyone gathered around the bed three days later commiserating at the end of a wonderful career.

    It’s not that “profit motive from consolidation of healthcare providers” is irrelevant; it’s that it’s nowhere near a complete explanation. And that’s before asking the question of whether a MAS*H-style ward of a dozen beds separated by 2 meters or so would be appropriate when dealing with infectious disease in the first place…

  4. Jazzlet says

    The UK has the same problem, largely due to underfunding under Tory governments, but also due to politicians not understanding that you can’t run all hospitals on 100% occupancy while still having capacity to deal with emergency admissions.

  5. jsrtheta says

    I’ve had two hip replacement surgeries (same hip – they wear out).

    In 1986, after the first surgery, the hospital kept me there to monitor my recovery and give me physical therapy. I was there for a couple of weeks, by which point I was ambulatory and could literally walk home (on crutches, but still).

    In 1995, I was out two days after the surgery. I lived about 100 miles from the hospital, in the mountains, and needed someone to get me home. When I asked about physical therapy, I was told “You know all this stuff from your last surgery.” I hobbled on crutches, in pain, to the car that was taking me home. Once there, I was off for the next couple of weeks from work because I was still in pain and still couldn’t really walk.

    I guess they needed the bed.

  6. davidc1 says

    @5 Yeah,we are also short of Drs and Nurses,never mind that twat faced twat johnson has promised us 40 new Hospitals,
    and I for one believe him.

    That was sarcasm by the way.

  7. mcfrank0 says

    Commenter Jaws is correct. The story is a lot more nuanced than “capitalism”.

    The period of time covered in the article just happens to cover my career in inpatient healthcare. Advances moved a great deal of care from inpatient to outpatient settings. Other improvements to treatment reduced or even eliminated the required length of stay. All of these changes actually reduce the revenue for inpatient care facilities.

    In addition, although the overall number of beds has been reduced, the mix of beds has radically changed. The number of intensive care beds exploded along with a differentiation of care types. This is especially important to remember as COVID cases need ICU care., not a general medical bed.

    I am sorry to hear jsrtheta’s story. My partner actually has a similar history with hip replacement surgery, but with much better results. When I first started working a broken hip was looked on as the beginning of a downward spiral toward death for elderly patients. Sports medicine showed that better outcomes were possible, albeit with lengthy hospital stays. Currently, hip replacement patients are encouraged to walk the next day.

    Inpatient hospitals are the most expensive way to provide care. Not coincidentally, they are the most dangerous places for patients regarding nosicomial infections. Extended care is now provided at specialized care facilities. jsrtheta should have been transferred for a short stay at a rehab center. I’m guessing that it was denied by their insurance provider.

  8. says

    This is what happens when an entire generation just does without healthcare because we can’t afford it.
    I know given the choice between a lifetime of debt for a critical life saving operation or just dying, I’d probably just die.
    That’s where we’re at now. Just dying is a viable and sometimes preferable option.

  9. mcfrank0 says

    Oops. I forgot to mention an example from my closest area of care.

    When I first started working, a patient experiencing a suspected heart attack was immediately admitted to a cardiac care unit on complete bedrest and was administered only supportive treatment. There was no choice but to let a section of the heart muscle die. Cardiac catherization and possible open heart surgery would wait until the patient was “stable”. This could take weeks and multiple hospital stays.

    Skipping to today, and many intermediate improvements, a finger stick can immediately determine if you are suffering a heart attack. You can then be sent immediately to the cath lab and the blockage is removed stopping any permanent damage , if any, to the heart. Depending on the severity of the disease, other blockages maybe opened in the cath lab or the patient is scheduled for open heart surgery. The patient may go home anywhere between the next day or the next week with minimal to no immediate aftereffects depending on how quickly they arrived in the ED after experiencing symptoms.

    Similar fast tracks were developed for those patients who were experiencing possible cardiac symptoms but were not actively demonstrating damage to the heart.

    The point: a lot less cardiac beds were needed along with better outcomes.

  10. says

    The usual suspects in Canada are using the overcrowded hospitals that haven’t been helped by decades of healthcare cuts lowering our number of beds and staff are using this as an opportunity to push for more privatization.