Melnick Glenn
Price School of Public Policy, University of Southern California, Los Angeles, CA 90089-0626, USA.
Healthcare (Basel). 2025 Jun 13;13(12):1424. doi: 10.3390/healthcare13121424.
This study investigates the evolution of hospital capacity and utilization in California between 2003 and 2023, focusing on emergency departments (EDs) and trauma centers (TCs). We seek to document structural changes in the healthcare delivery system with respect to hospital-based emergency and trauma services. This analysis examines changes in population demographics, hospital resources, and patient utilization patterns across facility types. Given the significant increase in the proportion of the population aged 65+ and the documented higher use of emergency and trauma services by this population, we expected to observe an expansion in ED and trauma service capacity and utilization. Utilizing a comprehensive dataset of California general acute care hospitals over this 20+ year period, our descriptive analysis reveals major shifts in the healthcare delivery system, notably the increased prominence of hospitals with EDs, particularly those designated as trauma centers. Findings indicate that, while the overall number of hospitals and licensed beds has slightly decreased, facilities with EDs, especially trauma centers, have increased their capacity and manage a greater proportion of inpatient admissions and ED visits. The increase in ED visits and inpatient admissions at trauma centers, contrasted with decreases in both capacity and utilization at non-trauma hospitals, indicates a significant restructuring of the health delivery system with significant implications for healthcare policy, financing, operations, and affordability. The high and increasing percentage of inpatient admissions originating from hospital EDs and from hospitals with trauma centers suggests a need for policies that foster integration between ED and inpatient care and the broader healthcare delivery system, while at the same time managing the increase in prices and costs associated with growing emergency services utilization. Further research is needed to explore the implications of these trends, particularly concerning their impact on the affordability of healthcare in the US.
本研究调查了2003年至2023年加利福尼亚州医院容量及利用情况的演变，重点关注急诊科（ED）和创伤中心（TC）。我们试图记录医疗服务提供系统在基于医院的急诊和创伤服务方面的结构变化。该分析考察了不同类型医疗机构在人口统计学、医院资源和患者利用模式方面的变化。鉴于65岁及以上人口比例显著增加，且该人群对急诊和创伤服务的使用记录更高，我们预计会观察到急诊科和创伤服务容量及利用情况的扩大。利用这20多年间加利福尼亚州综合急性护理医院的全面数据集，我们的描述性分析揭示了医疗服务提供系统的重大转变，特别是设有急诊科的医院，尤其是那些被指定为创伤中心的医院，其地位日益突出。研究结果表明，虽然医院总数和持牌病床数量略有下降，但设有急诊科的机构，尤其是创伤中心，已提高了其容量，并管理了更大比例的住院患者入院和急诊就诊。创伤中心急诊就诊和住院患者入院人数的增加，与非创伤医院容量和利用率的下降形成对比，这表明医疗服务提供系统发生了重大重组，对医疗政策、融资、运营和可负担性具有重大影响。来自医院急诊科和设有创伤中心的医院的住院患者入院比例居高不下且不断上升，这表明需要制定政策，促进急诊科与住院护理以及更广泛的医疗服务提供系统之间的整合，同时应对与急诊服务利用增加相关的价格和成本上涨问题。需要进一步研究来探讨这些趋势的影响，特别是它们对美国医疗可负担性的影响。
