Jarman B
Department of General Practice, St Mary's Hospital Medical School, Lisson Grove Health Centre, London.
BMJ. 1993 Apr 10;306(6883):979-82. doi: 10.1136/bmj.306.6883.979.
To examine whether there are too many hospital beds in London.
Analysis of data from the Hospital In-Patient Enquiry, Mental Health Enquiry, health service indicators, and Emergency Bed Service.
England, London, and inner London.
Hospital admission rates for acute plus geriatric services for London residents were very similar to the national values in all age groups. In the special case considered in the Tomlinson report--acute services in inner London--the admission rate was 22% above the value for England. However, the admission rate of inner deprived Londoners was 9% below that of comparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded, in 1990-1 there were 4% more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985.
Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London's relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and evidence from the Emergency Bed Service of increasing pressure on beds. Higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally.
研究伦敦是否存在医院床位过多的情况。
对医院住院患者查询、心理健康查询、卫生服务指标及急诊床位服务的数据进行分析。
英格兰、伦敦及伦敦市中心。
伦敦居民急性病加老年病服务的住院率在所有年龄组中与全国水平非常相似。在汤林森报告所考虑的特殊情况——伦敦市中心的急性病服务中，住院率比英格兰的水平高22%。然而，伦敦市中心贫困居民的住院率比伦敦以外类似地区低9%。对于精神病学，伦敦的住院率大致与类似地区相当。排除特殊卫生当局后，1990 - 1991年伦敦每位居民可获得的急性病加老年病床位比英格兰多4%。伦敦床位的减少速度比全国更快。推断床位关闭的趋势表明，伦敦现在每位居民的床位（包括所有床位和急性病床位）约为全国平均水平。急诊床位服务的数据表明，自1985年以来，伦敦现有医院床位的压力一直在增加。
关于伦敦居民所有专科床位供应和使用情况的数据，并未表明有理由以比其他地方更快的速度减少伦敦医院床位的总数。床位关闭应考虑到伦敦相对较差的社会和初级卫生保健环境、更长的医院候诊名单、较差的养老院供应情况以及急诊床位服务显示的床位压力不断增加的证据。伦敦较高的平均成本（有些是不可避免的）正迫使伦敦医院床位关闭的速度比全国更快。
