Healthy Development Measurement Toolkit

Indicator PI.4.c Number of hospital beds per 100,000 population

Data Source

California Department of Health Services. Office of Statewide Health Planning and Development (OSHPD). Healthcare Quality and Analysis Division. Hospital Annual Utilization Data, Final 2007 Database. Accessed on September 29, 2009: http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/Hosp_Util_Info.html

San Francisco Population estimate from Applied Geographic Solutions, Inc. Spring 2007 Update: Current Year Estimates. Methodology available at: http://www.appliedgeographic.com/library.html.

Definitions Source: CA DHS. OSHPD. ALIRTS User Guides, Forms and Instructions. Instructions for Completing Annual Utilization Report of Hospitals. Report Period January 1, 2007 through December 31, 2007. Accessed on September 29, 2009: http://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital

Explanation and Limitations

As of September 2009, there are 15 hospitals that report annual utilization data to the CA Office of Statewide Health Planning and Development (OSHPD). Thirteen of the hospitals are licensed as general acute care (GAC) facilities and two are licensed as psychiatric (PSY) facilities. San Francisco General Hospital is the only Level 1 Trauma facility in the City.

OSHPD provides the following definitions for hospitals reporting annual utilization data (Accessed on September 29, 2009: http://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital):

• "Licensed beds" are the number of beds licensed by DHS, Licensing and Certification Division on the last day of the reporting period (December 31, 2007 for the data above).  This includes beds placed in suspense. There are six licensed bed classifications: General Acute Care, Chemical Dependency Recovery Hospital, Acute Psychiatric, Skilled Nursing, Intermediate Care, and Intermediate Care/Developmentally Disabled. There are nine bed designations within the General Acute Care Classification: Medical/Surgical, Perinatal, Pediatric, Intensive Care, Coronary Care, Acute Respiratory Care, Burn, Intensive Care Newborn Nursery, and Rehabilitation Care. The totals included all classifications by hospital.
• "Licensed bed days" are the number of licensed beds multiplied by the number of days in the reporting period.  This calculation reflects changes in actual bed capacity during the year and is used to calculate occupancy rates (Patient (Census) Days/Licensed Bed Days = Occupancy Rate). 
• "Licensed bed days per 100,000 population" was calculated by taking the licensed bed days by hospital and dividing by the estimated number of persons residing in San Francisco (2007 estimate from Applied Geographic Solutions was 725,179), then multiplying by 100,000. Calculations conducted by the San Francisco Department of Health, Environmental Health Section.
• "Discharges" are the number of formal termination and releases by the hospital of inpatient hospitalization, excluding nursery. Deaths are included in discharges. Transfers between types of care (acute, psychiatric, chemical dependency, skilled nursing, intermediate care) are also considered “discharged and readmitted”.
• "Patient (Census) days" are the sum of all inpatient daily census counts (excluding nursery) for each day of the reporting period (i.e. cumulative patient census.) The reporting period is the calendar year unless the hospital was not in operation all year.
• "Hospital beds per 100,000 persons" is an indicator of hospital capacity that is frequently used to conduct international and intra-national comparisons of the availability of health care services.

According to a recent study by the Kaiser Family Foundation, community hospital capacity (excluding psychiatric hospitals) in the United States has decreased over the last thirty years as a result of shorter lengths of stay in hospitals and increased use of outpatient procedures. In the past five years, the decline has leveled off, but remains two-thirds the capacity of hospitals in 1975. (Accessed on September 29, 2009: http://www.kff.org/insurance/7031/ti2004-5-2.cfm)

Similar to other indicators of health care availability, the number of hospital beds per 100,000 population is a limited indicator influenced by numerous confounding factors. For example, a reduction in the number of hospital beds may occur because the hospital is underfunded and/or not sufficiently reimbursed in a timely manner by state agencies or insurance companies to stay afloat economically. Or, a reduction in the number of beds may occur because the hospital's primary base population is becoming increasingly healthy and preventative and outpatient care have limited the need for inpatient care. In the first example, the hospital is not able to keep up with the demands of the community, and in the second example, the demand for hospital utilization has decreased.

As mentioned in other indicators, demographic shifts brought on by changing housing and economic contexts will also result in patient demographic shifts in hospitals and the associated hospital utilization. Older populations tend to have longer, in patient care than younger populations. Populations without access to health insurance tend to arrive at the hospital in a more advanced stage of disease or illness progression, thus necessitating inpatient visits, than persons with health insurance. Younger populations tend to utilize obstetric and emergency room services more frequently, whereas older populations tend to utilize internal medicine, surgical and geriatric services more frequently.

Because of these limitations, longitudinal analyses of hospital bed availability, combined with patient censuses (to help calculate the percentage of days the beds are occupied) and socio-economic analyses of the hospital and surrounding hospital, are helpful in assessing availability and quality of health care. Additionally, other factors such as health insurance coverage, transportation to and from the health facility, cultural competency or cultural humility of health care providers, length of reimbursement period, cultural and linguistic competency of administrative and intake staff, availability of child care, availability of prevention programs, and employer requirements are other factors to be considered in assessing the availability of reliable, continuous access to affordable, quality health care.

Why is this a Community Health Indicator?

Similar to the number of physicians and nurses per 100,000 population, hospital beds per 100,000 population is an indicator of the availability of health care services and hospital capacity relative to the general population.