A New Way to Think About Hospital Access

By Yaa Akosa Antwi, PHD
July 26, 2022

This week’s contributor is Yaa Akosa Antwi, an Assistant Professor of Economics and Management at the Johns Hopkins University Carey Business School. Her research focuses on understanding and quantifying how government policies and economic incentives affect health outcomes and the functioning of health care markets. Yaa is a member of the 2022 Tradeoffs Research Council.

Although access to health care has many dimensions, an important one is whether people living in a particular area have enough hospitals, with enough capacity, near where they live. The COVID-19 pandemic has overwhelmed many hospitals because of varying availability of beds, particular services, and staff to address the need for care. Understanding the distribution of hospital capacity and resources is crucial for responding to a public health emergency and can provide insight into where access might be a problem.

In a study recently published in Health Services Research, Thomas Hegland, Pamela Owens and Thomas Selden combined data on nonelective hospital stays with data on hospital characteristics, quality measures and sociodemographic information to measure the quantity and quality of hospital capacity. They used a new approach to measuring capacity that captured the flow of hospital patients within and across geographic areas and measured capacity at the zip code level. 

Using this new measure, the researchers found that: 

  • On average, U.S. residents live in zip codes with 2.31 total beds per 1,000 people. 
  • People 65 years and older live in zip codes with higher hospital capacity than younger people.
  • Compared to white people, non-Hispanic Black people live in zip codes with more beds on average, but these hospitals have higher occupancy rates, fewer staff per bed, lower quality and less capital per bed. Hispanic individuals reside in zip codes with fewer beds per capita, higher occupancy rate, fewer staff per bed but with more capital per bed. 
  • People with family incomes below the federal poverty level on average live in zip codes served by hospitals with lower staffing levels, spending and capital per bed than people with family incomes 200% or more of the poverty line.
  • Individuals in rural zip codes on average are served by hospitals with more beds and lower occupancy than those in urban zip codes.

This research has some limitations. While the researchers were able to demonstrate variation, they did not define what optimal or adequate hospital capacity would be. Hospital capacity and staffing is also difficult to measure with annual data as staffing and capacity change day to day. While zip codes are a reasonable measure of hospital markets, there is no consensus on how to measure hospital markets. Finally, capacity was measured using 2017 data which may be out of date.

Beyond the contribution of the new capacity measure, this research also highlights that access to high quality care is not only a question of the number of hospital beds. It shows that residents in areas with more hospital beds may still face access challenges if those beds are occupied, not adequately staffed or financially resourced, and care may not always be of the highest quality.

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