Comparing Presidents, Hospital Beds

This post is on hospital beds. Seriously. Here’s the idea. I tried to think of measures of the quality of healthcare, both in terms of outcomes and in terms of inputs. I’ll be leaving outcomes for another day. Inputs include things like number of hospitals, doctors, beds, etc. Number of hospitals doesn’t quite work… with consolidation and larger hospitals, fewer hospitals might be able to serve more people. Number of doctors might work, but from what I can tell from visiting friends and relatives in the hospital over the years, most care is provided by nurses. Number of nurses might work, but I suspect the quality of nurses can vary quite a bit.

And then there are hospital beds. While its possible the number of hospital beds per thousand people might decline over time as the population gets healthier (e.g., fewer beds are needed for polio victims these days than in 1923), for the most part, more beds means more capacity to care for patients, and fewer beds means less capacity to care for patients, regardless of whether that care is provided by doctors, nurses, midwives, etc.

FWIW, the main reason I’m going with hospital beds is this… (Long time readers may recall this as I’ve mentioned bits and pieces before.) When I was in grad school, most of my classmates were of the, um, foreign persuasion. Most of the Latin American students were male, married, and a bit older, and they brought their wives and children with them. And most of them were sent by the government to get a Ph.D. after which they would return to a high level position. In plain English – these were people with resources, and pretty good health insurance both at home and here in the US. Anyway, most of these foreign students reproduced while here in the US. And here’s the interesting thing… in every single case the wife went home to deliver the resultant offspring. This didn’t mesh with my absolute knowledge that the US had the best healthcare system in the world, so eventually I asked what the deal was. And this is what I was told: “If my wife goes home, she’ll be in the hospital for a week, and in that time the hospital can catch any problems that develop. Plus she’ll be around family. But if she has the kid here, they’ll kick her out of the hospital the next day or the day after.”

Not that I expect the experience of upper crust Mexicans and Peruvians and Chileans and so forth is at all representative of not-upper crust Mexicans and Peruvians and Chileans and so forth, but it seems to me that it takes more hospital beds to keep grieving, make that recent mothers in the hospital for a week than it does to keep them there for 24 to 48 hours.

Its not a perfect measure, but its what I’m going with. (Your thoughts on the use of this measure are welcome. I can be persuaded to put another measure on the to-do list.)

OK. Data on hospital beds is available from 1970 to 2003 from The World Bank’s Health, Nutrition and Population data platform and for various years including 2004 from the Statistical Abstract of the United States. I made sure the data matched up where the series overlapped, and it does, including for past editions of the Statistical Abstract which contain data on hospital beds, so I think its reasonable to conclude the World Bank’s source is also the Census’ (they’re the ones that put together the Statistical Abstract) source, at least when it comes to data on hospital beds in the US.

So here’s the graph…

Gazork! Capacity is decreasing over time. Now, unless there was a huge surplus of hospital beds, or people are just not getting sick any more, this is probably not a good trend. More the function of cost cutting than interest in providing care.

Next, we have a summary of the results.

Clinton doesn’t do so well. It might have something to do with him doing the best job of cutting health care costs. Cutting health care costs could be accomplished by providing less health care. (We’ll try to measure outcomes in a future post so we’ll see if that’s true then.) Of course, Carter was second best at containing health costs, and he was third best on this list.

A more interesting point… this is the first series that I’ve looked at so far that GW actually comes out best. Reagan comes in second.

Now one more thing I’d like to do… Below is an international comparison… hospital beds per thousand people for all countries for which the World Bank has that data for the year 2000. Every single one.

As an American, I’m not sure I like where the US is sitting. More beds doesn’t necessarily mean a better system; I think most of us would agree that some former Soviet states have lousy healthcare systems. But what about Japan or Germany? They get healthcare outcomes (longevity, infant mortality, etc.) that are at least as good as American outcomes, at much lower cost. And the opportunity for care seems greater there.

So I’ll close with two thoughts…

1. I keep hearing that the US has the best healthcare system in the world. People who say that are quick to point out the output of American pharmaceutical companies, and how wealthy foreigners come to the US for exotic operations. That strikes me the same as arguing that Italy has the best transportation system in the world because wealthy people the world over choose to drive Ferraris and Lamborghinis. Folks who make this argument never ask themselves questions like… how many Italians are driving Ferraris, and what are the roads like in Italy?

2. As always, readers are welcome to prove me wrong. The World Bank’s Health, Nutrition and Population data platform has data on a whole lot of series, even for fictional countries like Australia and evil countries like France (sure, for the time being, after the last election we’re pretending they’re not evil, but they’ll be going back to their nefarious socialist ways any time, I just know it) and Canada. I have no spent quality time with that data repository – I just discovered it yesterday. If you spot a healthcare related series for which the US is doing better than everyone else there or anyplace else that seems reputable, let me know. (Topping the world on spending does not make the US better.) Mention it in comments or send me an e-mail. I will put it in a post.


correction… minor change to last sentence discussing the summary table.