California has 1.9 hospital beds per 1,000 people, the least of the 10 most populous states, according to a new report from the California HealthCare Foundation.
New York and Pennsylvania, two of the most populous states, have 3.2 beds per 1,000 people, followed Ohio, which has 2.9 beds and Florida, Georgia, Illinois, North Carolina, Michigan, and Texas, which have between 2.9 and 2.4.
Maribeth Shannon, director of the Foundation's Market and Policy Monitor program for the Foundation, says that trend is probably due to California's "high reliance on HMO coverage, plus we have a healthier and younger population than many other states."
California also may have fewer hospital beds than other states because many hospital projects statewide have been delayed because of questions about compliance with state seismic regulations. But also, other state hospital systems may have grown too much in decades past for recruitment and competitive reasons and in anticipation of greater reimbursement.
The report notes that California also has strikingly fewer admissions per 1,000 people compared with the nation as a whole. For example, the U.S. admission rate dropped slightly, from 119 to 117, between 2001 and 2007, whereas in California, admission rates slid from 98 to 90.
"It is likely that the shift to outpatient care slowed the growth in inpatient utilization," the report said.
But the document, entitled the California Health Care Almanac, also illustrates a disturbing trend of hospitals closing their doors, which some healthcare officials fear will only get worse due to California's poor financial climate and its seismic regulations, many of which require massive retrofits and rebuilding to withstand possible earthquakes.
In all, 27 acute care hospitals closed their doors statewide between 2001 and 2007. But 11 of those, representing 58% of the licensed beds in the state that closed, were in one county: Los Angeles, the report said.
Jan Emerson, spokeswoman for the California Hospital Association, says all 27 closures were due to financial reasons. "When it comes to measures such as financial performance, charity care, etc., I would expect to see those numbers get even worse if you look at 2008-2009," she says.
California lost 3,500 hospital beds between 2001 and 2007, most of which were dedicated for skilled nursing, intermediate care, psychiatric, and chemical dependency, but the number of general acute care beds remained relatively stable.
The foundation report suggests that hospitals are moving away from those services to provide "more profitable acute care services."
Shannon says an important aspect of the report was how it illustrated great geographic disparity in the location of hospital beds within the state. For example, Los Angeles, where 11 hospitals had closed between 2001 and 2007, still has the highest number of licensed beds per 1,000 population, 2.5, compared with the fast-growing Inland Empire, which includes Riverside and San Bernardino counties, which have only 1.7.
Also of interest is that 62% of the licensed beds in the state are owned by non-profit hospitals, 18% are investor-owned, 7% are district hospitals, and 13% are public hospitals.
The report briefly mentioned the challenge faced by many of California's remaining 400 hospitals, which must comply with earthquake safety requirements.
"More than 200 acute care hospitals still have buildings that are in danger of collapse during an earthquake and must be replaced by 2013," the report says.
The Office of Statewide Health Planning and Development, the state agency that has the authority to approve hospital seismic safety, provided a more recent count yesterday, saying that 242 hospitals currently don't meet 2013 requirements, and those hospitals collectively have 819 buildings that aren't in compliance.
"However, not all have to be replaced by 2013," explains OSHPD spokesman David Byrnes. "Some are eligible for extensions to 2015 and/or 2020. Also, some may be eligible for reclassification," in which they would be deemed safe enough that they would not have to meet such strict standards.