Are New Zealand’s hospitals focussed on ‘system improvement’?
Over the past twenty years, the majority of high-income nations have seen a reduction in their hospital bed capacity. Decreases in bed numbers and shifts in related indicators such as length of stay or bed occupancy rates are often interpreted as evidence of more efficient resource allocation. However, they may also indicate a decline in the adequacy of health care provision to patients. Observational studies have linked high bed occupancy rates to increased mortality, reduced admission rates, and elevated readmission rates.
In New Zealand, a decline in bed availability and the number of bed days has been evident for at least two decades within hospital boards and, more recently, in DHBs, spurred by population-based funding. Despite nearly two decades of the Ministry of Health publishing data on hospital utilisation and throughput, there has been minimal analysis of these trends.
District health boards (DHBs), through their integrated approach combining hospital/secondary care with primary/community-based services, are uniquely positioned to develop alternatives to costly hospital care. The rising pressures on DHB resources and the formation of a structured primary health care system have initiated various projects through DHBs in collaboration with Primary Health Organisations (PHOs) to create significant community-based alternatives to hospital treatment.
Hospital beds are a pivotal element in the provision of health care services, yet they represent merely a fraction of the broader health care framework, with the majority of health care being administered without the necessity for a hospital bed. The term 'beds' generally implies those that are fully staffed, funded, and ready for patient use, as beds require personnel and accompanying equipment to facilitate care.
The requisite number of beds for effective health care delivery, alongside their utilisation, hinges on a variety of interconnected considerations. These considerations can be grouped into three main categories: underlying patient demand; national policy – encompassing funding, workforce availability, and access standards; and local conditions – such as the presence of alternative services and internal hospital procedures. Demographics, population characteristics, and patient behaviour influence demand. National policy dictates the response to this demand, whilst local conditions play a critical role in managing demand at the community level.
As these dynamics evolve over time and vary regionally, the essential number of beds required by the health service to ensure optimal service provision also fluctuates over time and differs from one area to another.