U.S. hospital occupancy has stabilized at 75.3%, 11.4 percentage points higher than the pre-2020 63.9% average, due to a 16% decline in staffed beds (802,000 to 674,000), while the mean daily census has remained approximately 510,000, according to a recent study.
Researchers conducted a cross-sectional study to analyze national hospital bed occupancy trends and forecast potential shortages driven by an aging population. Using data from the U.S. Department of Health and Human Services COVID-19 dashboard, which mandated weekly hospital occupancy reporting from August 2020 to April 2024, the researchers examined mean daily census and inpatient bed supply across nearly all U.S. hospitals. Projections for future hospital demand were based on age-adjusted hospitalization rates derived from the 2019 to 2020 National Inpatient Sample and U.S. Census Bureau population projections for 2025 to 2035.
Published in JAMA Network Open, the study found that mean hospital occupancy increased from 63.9% (range = 63%-66%) between 2009 and 2019 to 75.3% (range = 72%-79%) from May 2023 to April 2024 following the COVID-19 public health emergency. This rise corresponded with a 16% reduction in staffed hospital beds, from a pre-pandemic steady state of 802,000 beds (2009-2019 mean) to 674,000 beds postpandemic, while the mean daily census remained approximately 510,000 patients. State-level variations in postpandemic hospital occupancy were substantial.
Based on current hospitalization rates and bed supply, the researchers projected total annual hospitalizations will increase from 36.2 million in 2025 to 40.2 million in 2035 due to population aging. Consequently, national hospital occupancy is expected to reach 85% by 2032 for adult beds and by 2035 for adult and pediatric beds combined. This threshold, considered indicative of a national hospital bed shortage, raises concerns regarding hospital capacity and patient care.
Led by Richard K. Leuchter, MD, of the Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA in Los Angeles, California, the investigators identified potential mitigation strategies, such as a 10% increase in staffed hospital beds, a 10% reduction in hospitalization rates, or a combination of both. However, the projections did not account for increasing length of stay, evolving population health trends, or resource reallocation challenges, such as ICU-to-floor bed conversions or workforce mobility between states.
The findings highlight ongoing challenges related to hospital staffing shortages and bed availability. Future research should examine the factors contributing to the decline in staffed hospital beds, including health care labor market constraints and hospital closures, and assess potential strategies such as geographic resource distribution and alternative care models to improve hospital capacity.
Full disclosures can be found in the published study.