Department of Medicine, Cambridge Health Alliance, Cambridge, MA.
Harvard Medical School, Boston, MA.
Med Care. 2024 Jun 1;62(6):396-403. doi: 10.1097/MLR.0000000000001999. Epub 2024 Apr 10.
The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.
To explore the distribution of physical hospital resources-that is, capital assets-in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.
We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020-2021 Area Health Resource File; 2016-2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community's medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders.
Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45-102) and $19 in spending per bed day (95% CI: 12-26).
The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.
提供高质量的医院护理需要足够的空间、建筑和设备，尽管冗余的基础设施也可能导致服务过度提供。
探索美国医院实物资源的分布情况，即资本资产；其与社区健康和非健康因素指标的相关性；以及医院资本密度与区域医院利用和成本之间的关联。
我们通过分析 2019 年医疗保险成本报告；2019 年州住院数据库社区住院统计数据；2020-2021 年区域卫生资源档案；2016-2020 年美国社区调查；2022 年 PLACES；和 2019 年 CDC WONDER，创建了一个由 1733 个美国县组成的数据集。我们首先计算了县一级的医院资本资产和投资总额。接下来，我们研究了社区的医疗需求（如慢性病患病率）、支付能力（如保险）与供应因素与 4 种资本可用性指标之间的相关性。最后，我们在调整混杂因素后，研究了资本资产与医院利用/成本之间的关联。
人口老龄化和病情较重的县，人均、每住院日和每出院人次的医院总资本通常较少，而收入或保险覆盖率较高的县拥有更多的医院资本。在控制医疗需求和支付能力的线性回归中，资本资产与更高的医院利用率和成本相关，例如，人均资本增加 1000 美元，每 10 万人的出院人数增加 73 人（95%CI：45-102），每床位日的支出增加 19 美元（95%CI：12-26）。
医院投资水平与社区财富有关，但与人口健康需求无关，可能会推动利用和成本。
