Statistics are sometimes misleading, but in the case of a shift in focus in healthcare from inpatient to outpatient care, they tell a lot of the story.
According to the 2001 edition of the American Hospital Association's Health Statistics, hospitals nationwide admitted 36.8 million patients and handled nearly 271 million outpatient visits in 1976. In 1999, the latest year for which the statistics are available, admissions had declined 7%, to 34.2 million inpatients, while outpatient visits had shot up to 573.5 million-a 112% increase.
Another way to express the shift from the hospital inpatient bed to outpatient settings, including skilled-nursing facilities and home health visits, is by looking at average length of stay, which fell to 5.9 days in 1999 from 7.7 days in 1976, according to the AHA.
The numbers can't tell us why care shifted, however. Uwe Reinhardt, a professor of economics and public affairs at Princeton University, says both clinical and financial changes answer the question.
"Genuine medical advances for shortening stays, or eliminating them altogether, is one thing," Reinhardt says, adding that clinical advances that have been good for patients-the increasing number of surgical procedures that can be handled in outpatient settings, for instance-have also brought economic efficiencies in care.
"But it is entirely something else to kick mothers (who just gave birth) out of bed after two days, and think you're saving $2,000, when you're really only saving $200 or $300," he says. "There was an obsession with cutting length of stay."
Reducing admissions and trimming length of stay point to another factor: Intense cost-cutting pressure on hospitals from payers. Both government programs, such as Medicare, which pushed care out of the hospital with the introduction of DRGs in 1983, and managed-care plans applied the pressure.