[EQ] Hospital capacity planning: from measuring stocks to modelling flows

Hospital capacity planning: from measuring stocks to modelling flows

Bernd Rechel ^a, Stephen Wright ^b, James Barlow ^c & Martin McKee ^a
a. European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London England.

b. European Centre for Health Assets and Architecture, Utrecht, Netherlands

c. Health and Care Infrastructure Research and Innovation Centre, Imperial College Business School, London, England.
Bulletin of the World Health Organization 2010;88:632-636. doi: 10.2471/BLT.09.073361
Volume 88, Number 8, August 2010, 561-640

Available online at: http://bit.ly/cB0hju

“……….Although revenue for hospital services in many developed countries is increasingly based on measures of activity such as diagnosis-related groups, hospital capacity planning remains dominated by “bed numbers”.¹  A review of international practice found that bed capacity continues to be the preferred unit for planning hospital care in Finland, Germany, Italy, New Zealand and most Canadian provinces. Of the countries included in the review, only England and France were moving towards planning based on service volume and activity.^2,3 Bed occupancy and the ratio of beds per population remain predominant metrics in hospital capacity planning.^4–6

There are several problems associated with this approach. Most importantly, bed numbers or bed occupancy do not provide a good measure of the services provided inside hospitals, given the wide variation in case mix and thus treatment costs of those occupying the beds,⁴ nor are they suitable for predicting future demand.⁷ The measure implies that the bed is the core piece of capital stock in the hospital, constraining the performance of the other assets around it. The near universal trend towards growing numbers of day cases and shorter lengths of hospital stay further invalidates beds as a measure of capacity.

The continued use of “bed numbers” also fails to consider the trade-offs and complementarities from investing in different types of health capital. Thus, while bed numbers have the benefit of convenience, as they are one of the few indices of hospital capacity that are routinely collected, there is a growing recognition of the intrinsic limits of this measure….”

http://www.who.int/bulletin/volumes/88/8/09-073361/en/index.html

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