Why the U.S. Doesn’t Have Enough Hospital Beds: Sometimes too much efficiency can be a bad thing
Excerpts from an article by Stephen Mihm,
Given the possible influx of patients sickened by the new coronavirus, how much of a surge can U.S. hospitals accommodate?
“Not as much as you might think. For years, cost-conscious hospitals have emulated the lean, just-in-time principles that have revolutionized manufacturing.
“From 1945 to 1983, hospitals in the United States kept approximately 75% of beds in use, leaving a quarter ready for unanticipated surges.
“The turning point came in 1983, when Congress transformed how Medicare reimbursed hospitals.
“By the early 1990s, the number of beds per 1,000 population had fallen by 50% from its peak.
“Worse, there were growing signs of strain on emergency rooms and intensive care units. Between 1997 and 2004 alone, 12% of the nation’s 24-hour emergency departments closed entirely. They weren’t profitable, particularly given that many of the people who showed up in them lacked insurance to pay for the visit.
“Increasingly crowded waiting rooms meant longer waits. This in turn led more patients to leave without being seen at all. In California alone, for example, the number of visitors to emergency departments who left against medical advice shot upward by 57% from 2012 to 2017.
“..studies over past 20 years have highlighted that while the system can handle normal levels of patient admissions, it’s ill-prepared to handle something like a pandemic.
“Since 2000, a growing number of health-care providers adopted the just-in-time inventory methods pioneered by auto manufacturers. For example… … [Chicago] Mercy proceeded to cut its on-hand inventory by 50%. This included the equipment most critical for handling a pandemic, such as respirators.
“No health care organization has gone out and stockpiled lots of personal protective equipment. They have bought it on a just-in-time basis.”
“…the pandemic may do more than kill people and sow chaos. It may do something more shocking still: destroy the quaint belief that market forces can cure all that ails us.