Do More Hospital Beds Lead to Higher Hospitalization Rates?

Summary of Study: Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

Study by: Paul L. Delamater, Joseph P. Messina, Sue C. Grady, Vince WinklerPrins, Ashton M. Shortridge

A study, authored by Paul L. Delamater, Joseph P. Messina, Sue C. Grady, Vince WinklerPrins, Ashton M. Shortridge titled, “Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law” explores the relationship between hospital bed availability and utilization for the state of Michigan. Roemer’s Law states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content.

  • As of 2010, Michigan had a population of 9,883,640 residents served by 169 acute care hospitals with 26,180 total licensed inpatient beds. In 2010, there were 1,127,576 hospital admissions of Michigan residents to Michigan hospitals and a total of 5,313,149 days spent in hospitals, resulting in an overall patient day utilization rate of 0.537 patient days per person. For every 1,000 people, there were 9.51 hospital admissions per month, which is slightly higher than the national average.
  • Known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law.
  • Compelling evidence was found that a positive relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is proportional with changes in the geographic scale of analysis.
  • The research found a positive, association between hospital bed availability and hospital utilization rates. The nature of the research design limits the ability to establish a causal link between hospital bed availability and utilization rates. However, given the research approach, the magnitude and significance of the observed relationship, and the stability of the relationship over levels of data aggregation, the authors of the study believe that they have provided the most compelling evidence to date of the existence of Roemer’s Law.

Building new hospitals and creating additional inpatient capacity ignores current trends in healthcare being promoted by governmental and private payers towards payment models that reward alternative delivery models and promote the coordination of care among hospitals, physicians, and long term care providers to reduce inpatient care and to reduce length of stay for those needing to be hospitalized.

Full study is found here:  http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0054900