Healthcare Analysis & Forecasting, Wantage OX12 0NE, Oxfordshire, UK.
Int J Environ Res Public Health. 2024 Aug 6;21(8):1035. doi: 10.3390/ijerph21081035.
Three models/methods are given to understand the extreme international variation in available and occupied hospital bed numbers. These models/methods all rely on readily available data. In the first, occupied beds (rather than available beds) are used to measure the expressed demand for hospital beds. The expressed occupied bed demand for three countries was in the order Australia > England > USA. Next, the age-standardized mortality rate (ASMR) has dual functions. Less developed countries/regions have low access to healthcare, which results in high ASMR, or a negative slope between ASMR versus available/occupied beds. In the more developed countries, high ASMR can also be used to measure the 'need' for healthcare (including occupied beds), a positive slope among various social (wealth/lifestyle) groups, which will include Indigenous peoples. In England, a 100-unit increase in ASMR (European Standard population) leads to a 15.3-30.7 (feasible range) unit increase in occupied beds per 1000 deaths. Higher ASMR shows why the Australian states of the Northern Territory and Tasmania have an intrinsic higher bed demand. The USA has a high relative ASMR (for a developed/wealthy country) because healthcare is not universal in the widest sense. Lastly, a method for benchmarking the whole hospital's average bed occupancy which enables them to run at optimum efficiency and safety. English hospitals operate at highly disruptive and unsafe levels of bed occupancy, manifesting as high 'turn-away'. Turn-away implies bed unavailability for the next arriving patient. In the case of occupied beds, the slope of the relationship between occupied beds per 1000 deaths and deaths per 1000 population shows a power law function. Scatter around the trend line arising from year-to-year fluctuations in occupied beds per 1000 deaths, ASMR, deaths per 1000 population, changes in the number of persons hidden in the elective, outpatient and diagnostic waiting lists, and local area variation in births affecting maternity, neonatal, and pediatric bed demand. Additional variation will arise from differences in the level of local funding for social care, especially elderly care. The problems associated with crafting effective bed planning are illustrated using the English NHS as an example.
有三种方法/模型可用于理解可用和占用的医院床位数量在国际上的极端差异。这些模型/方法都依赖于现成的数据。在第一种方法中，使用占用的床位（而不是可用的床位）来衡量对医院床位的表达需求。三个国家的表达占用床位需求依次为澳大利亚>英国>美国。接下来，年龄标准化死亡率（ASMR）具有双重功能。欠发达国家/地区获得医疗保健的机会较少，导致 ASMR 较高，或者 ASMR 与可用/占用床位之间呈负斜率。在较发达的国家，较高的 ASMR 也可用于衡量医疗保健（包括占用床位）的“需求”，这是各种社会（财富/生活方式）群体之间的正斜率，其中包括土著人民。在英国，ASMR 每增加 100 个单位（欧洲标准人口），每 1000 例死亡的占用床位就会增加 15.3-30.7 个单位（可行范围）。较高的 ASMR 表明为什么澳大利亚的北领地和塔斯马尼亚州具有内在的更高的床位需求。美国的相对 ASMR 较高（对于一个发达/富裕的国家而言），是因为从最广泛的意义上讲，医疗保健并不普及。最后，提出了一种用于基准化整个医院平均床位占用率的方法，使它们能够以最佳效率和安全性运行。英国医院的床位占用率非常不稳定且不安全，表现为高“拒绝入院”。拒绝入院意味着下一位到达的患者无法获得床位。在占用床位的情况下，每 1000 例死亡的占用床位与每 1000 例人口的死亡之间的关系斜率显示出幂律函数。由于每年每 1000 例死亡的占用床位、ASMR、每 1000 例人口的死亡人数的波动而导致趋势线周围出现散点，以及隐藏在选择性、门诊和诊断等候名单中的人数的变化，以及影响产妇、新生儿和儿科床位需求的当地地区生育变化。由于当地社会保健资金水平的差异，尤其是老年人护理，还会出现其他差异。以英国国民保健制度为例说明了制定有效床位规划所涉及的问题。
