Does the statement “a built hospital bed is a filled hospital bed” still hold true?
Written by Tom Varghese
Induced demand (ID) is a long‑debated topic in the field of health economics. It is defined as the change in demand for healthcare associated with the discretionary influence of providers over their patients. As a complex and multi-dimensional phenomenon, ID is a major challenge for health systems worldwide that creates an imbalance between needs and available resources, thus increasing the incidence of a health expenditure rise.
ID might also undermine efficient allocation of resources. This situation can disturb the balance of supply and demand in the healthcare market while imposing an additional burden on the patients.
Research by Milton Roemer was the first study of Clinician‑ID, which became known in the healthcare market as the Roemer’s Law. This law states that “a built hospital bed is a filled hospital bed”. Although this theory has been proposed for hospital care, it can be extended to services offered by all clinicians. In theory, the ‘inefficiencies’ in healthcare provision sometimes incentivise the provision of unnecessary services that waste resources and impose additional costs on patients.
Two aspects of the Clinician-ID merit clarification. First, ID does not include actions that influence demand in the best interest of the patient. Indeed, moving demand toward the patient’s optimum is a responsibility of clinicians. Second, the definition leaves room for treatment to vary across patients and providers. The benefits and risks of treatments vary with patient characteristics, and it is the job of the clinician to tailor care to individual patients.
In other economies, a shift in national policy towards providing care outside of the hospital has seen a reduction in the number of fully staffed, funded and available hospital beds. However, more recently there has been growing concern that this has gone too far, and we now don’t have enough hospital beds. `The number of beds needed to provide health care effectively, and how they are used, depends on several interrelated factors. These can be thought of in three broad categories: underlying patient demand; national policy; and local circumstances.
In summary, we must question whether “a built hospital bed is a filled hospital bed” is simply a statement, a belief that has become entrenched in the lexicon of health services research or an actual process that can be observed.
