Healthcare wasn't entirely absent from last night's debate. When asked about the economy, both Republican candidate Donald Trump and Democratic candidate Hillary Clinton called for more infrastructure spending. But in his reply, Trump said:
“We have a country that needs new roads, new tunnels, new bridges, new airports, new schools, new hospitals,” he said.
New hospitals? That's not an area crying out for new investment, according to healthcare economists.
“Let me assure you that hospitals do not lack for modern facilities,” said Paul Ginsburg, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California. “Technology, including better care management, continues to reduce admissions.”
The numbers point overwhelmingly away from the need for expanded capacity in healthcare–especially in the in-patient setting. Admissions have declined to 34.9 million in 2014 from a 20-year peak of 37.5 million in 2008, according to the latest data from the American Hospital Association.
The average daily census has declined even faster as lengths of stay have fallen. It stood at 584,000 on average in 2014, down from 710,000 20 years ago.
“We already have too many small hospitals with low volume, poor outcomes, and 'hobbyist' surgeons who do a handful of procedures per year,” said Jon Skinner, a professor of economics at the Dartmouth Institute for Health Policy & Clinical Practice. “One thing we know is that low-volume is bad for patients.”
Indeed, the experts say building more hospitals would exacerbate the healthcare cost problem in the U.S.
“There are progressively so few procedures that require hospitalization that having too many tempts administrators to unnecessarily fill empty beds,” said Paul Hughes-Cromwick, co-director of the Altarum Center for Sustainable Health Spending.
Rather than building new hospitals, the nation needs to figure out better and more cost-effective ways of caring for an aging Baby Boom generation. Any new capacity should reflect both the changing nature of healthcare and the personal preferences of patients, experts say.
“Moving forward, the aging population will require more traditional hospital services, but a worthy goal for the nation would be to accommodate this growing demand without expanding capacity by reducing 'overuse' and emphasizing ambulatory and home-based modes of care delivery,” said Ani Turner, also co-director of the Altarum Center.
Even if we didn't have an overcapacity problem, experts say there would be a much better way to accommodate the demand of an aging population without expanding capacity.
Eugene Litvak, CEO of the Institute for Healthcare Optimization, has argued for years that U.S. hospitals, which operate at about two-thirds of capacity, could easily reschedule their predictable workflows to even out demand during the day and week. Hospitals in Canada and Western Europe routinely operate at 90% capacity utilization rates.
“To me, (what Trump said) sounded like why don't we spend our money in a casino,” Litvak said. “If the goal is to get something from the new investment (in infrastructure spending), then building more hospitals is not the best use of our money.”
