AYESHA RASCOE, HOST:
Too many patients, not enough beds. Research published in the Journal of the American Medical Association shows that the national hospital occupancy rate has gone up since the start of the coronavirus pandemic five years ago. And health experts are sounding the alarm about hospital bed shortages.
ARJUN VENKATESH: When occupancy goes above 85%, the whole system starts working a little bit slower. It gets harder to make sure that a patient can get an MRI. It gets harder to make sure that a patient can get their surgery in time. And the hospital starts to become more and more dysfunctional. Nationally, we're going to be above that 85% number in a few years if we don't do something to correct this.
RASCOE: Dr. Arjun Venkatesh chairs the Department of Emergency Medicine at the Yale School of Medicine. He described what's happening.
VENKATESH: What we are seeing is increasingly crowded hospitals and hospitals that are over capacity, more patients waiting to be seen, struggling to get the timely care they need.
RASCOE: Is it that we don't have enough hospitals or we just don't have enough beds for, like, population growth?
VENKATESH: It's all of those things at the same time. We have fewer hospitals, particularly hospitals that are in more rural areas or hospitals that may have fewer beds or smaller size, can't keep the budgets to stay open and so they have closed. And across health care - and this is what's happened new since the coronavirus pandemic - we're having a nationwide staffing crisis. And so what that's resulted in is alongside a country that's getting older and sicker with more and more needs for hospital care, less and less supply of both beds and the people that take care of you in those beds to match it.
RASCOE: So what happens to patient outcomes when a hospital is overloaded?
VENKATESH: When a hospital gets too full, the patients that are already admitted to the hospital get less and less care. They're in a hallway, they're in a room, in the emergency department waiting for a bed. Those patients are less likely to get their medications, more likely to experience harms, like delirium, and most of all, we know that those who are critically ill waiting for a bed are actually at increased risk of dying. At the same time, there's patients in a waiting room, and those patients either wait a long time and end up getting diagnosed late, or some even leave. And we know those patients who leave without being seen are at really risk of big, bad outcomes.
RASCOE: This is a nationwide problem, but is it worse in some regions?
VENKATESH: It's a nationwide problem, which is, if you look at almost any state in America in the national data, the crowding and what we call inpatient boarding in the emergency department is worse today than it was five years ago, and it was worse five years ago than it was 10 years ago. What's interesting, though, is if you look at any state in the country, there's a big distribution problem. At the same moment in time, one hospital may be totally overwhelmed, while there's another hospital in the same state that may be running at 60% occupancy.
You can't just simply pick up a patient and move them from one hospital to another. Not all hospital beds are the same. When we count hospital beds in this country, we count the little bassinets that are used for newborns the same as we count an ICU bed. You can't take a 70-year-old adult with a heart attack and put him in a baby's bassinet. The other challenge is that at some hospitals that deliver specialized care, there's much, much less capacity than there might be at a smaller hospital that doesn't have those specialized services.
RASCOE: You recently wrote about how federal policies that slash health care spending have led to this shortage. Tell us more about that.
VENKATESH: The situation we're in right now is highly predictable. Health care spending has long been a problem in the United States. We spend a lot of money and we don't get much for those outcomes, and it's put the federal and many state governments at risk of going bankrupt. Policymakers have kind of taken the Willie Sutton principle. Willie Sutton was a famous bank robber, and when you asked him, hey, Willie, why do you rob banks? And he would say, well, that's where the money's at. When we look at the pie of where we spend money in health care, the biggest piece of the pie is on hospital care. It's about a third of all of health care spending. And if I went back to the 1970s and '80s, we actually had more hospital beds then than we do now. But the population of the country was probably a hundred million less and the needs for hospital care were exponentially less.
And so what ended up happening is we said, well, there's probably too many hospital beds and laws were created that required a lot of approvals from state governments and others in order to build any new hospital beds. The other thing we did is we changed how we paid for hospital care. That, plus a lot of other financial incentives, made it increasingly not a great business to be in the hospital business. And you get to the mismatch we're at right now. I think that what federal policy is going to really have to do is figure out how to support making hospital beds cheaper to make new ones and figure out ways to change how we pay for hospital care so that it sort of matches the needs of the population.
RASCOE: Republicans in Congress have been weighing cuts to Medicaid and possibly Medicare as a part of the new budget bill in the coming months. Are you concerned that such cuts would impact the shortage of hospital beds that we have now?
VENKATESH: Hospitals across this country have been reliant on reimbursements from publicly insured individuals, whether that be the federal government in Medicare or state governments with Medicaid. And so if there were big cuts that happened in either program, I think it would make this whole problem even more fragile. There's a lot of hospitals around the country right now that are just barely eking by financially.
And if they even had a cut of half a percent or 1% from their publicly insured reimbursements, that could be the difference between staying open and closing. And you could imagine if more hospitals had to close, that would make this bed shortage problem even worse.
RASCOE: That's Dr. Arjun Venkatesh from Yale School of Medicine. Thank you so much for speaking with us today.
VENKATESH: Thank you.
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