OCHU

Ontario Hospitals: Bed Cuts and Hospital Overcapacity

• Over the last twenty years 18,581 hospital beds have been cut in Ontario. That is over 37% of total hospital bed capacity.
• Since 1980, over 30,000 hospital beds have been cut – a cut of 50%.
• In 2010, 610 hospital beds were cut, about 2% of hospital bed capacity.
Far Fewer Beds Per Capita
A new health care report from the Organization for Economic Cooperation and Development (OECD) indicates that the average number of hospital beds per capita of its 34 member countries was 5.14 beds per 1,000 population in 2008. Canada has an average well below the OECD rate: 3.3 beds per thousand population in 2008. That's about 64% of the 2008 OECD average. The OECD represents the most economically advanced countries in the world.

Ontario Lower Still
Ontario, however, is in a different league. In 2009, Ontario had a rate of 2.41 beds per 1,000 population, well less than half the OECD average and less than three-quarters of the Canada-wide average. In fact, Ontario has fewer hospital beds per capita than any other province.

Of all OECD countries, Ontario only managed to edge out Mexico and (possibly) Chile (pending final 2009 figures for Chile). Turkey increased its beds in 2009 pulling a little ahead of Ontario to 2.5 beds per thousand.
In 2010, Ontario's beds per thousand fell further to 2.33 per thousand. The announced health care funding plans will mean more bad news after the provincial election.

The situation is worse for acute care beds. Here, Ontario has a lower number of acute care beds per capita than any developed country, Chile and Mexico included. Indeed at 1.39 beds per thousand population we are 15% behind the next lowest country (Mexico at 1.6).
We truly are an outlier, well below the Canadian average (of 1.8 in 2008), and far below the OECD average (of 3.6 in 2008). Canada as a whole has 27% more acute care beds per capita than Ontario (using the 2008 data), while the OECD countries have, on average, 154% more.

Ontario also has the lowest average length of hospital stay of all provinces and has the fewest acute care hospitalizations per capita of any province.

Lack of Rehabilitation and Complex Continuing Care Beds
There was a total of 853,316 alternative level of care (ALC) days in Ontario hospitals in 2007-8. Mostly, these were for patients waiting for a different sort of bed. The report indicates that 27% of those days are accounted for by patients who were waiting for a complex continuing care or rehabilitation bed.

Rehabilitation and complex continuing care beds are different sorts of hospital beds, so this suggests the resolution of the ALC issue will need improvements in the capacity of Ontario hospitals in those areas.

A further 13% of days were accounted for by patients who died while in an ALC bed: this group was almost always either waiting for a palliative care bed, or waiting for another sort of bed.

Bed Occupancy moves to the stratosphere
Not surprisingly, Ontario has very high bed occupancy rates: currently about 97.9%. The British Medical Association connects high hospital bed occupancy with increases in hospital acquired infections. Britain aims to keep hospital bed capacity at less than 85%. Other countries have lower bed occupancy rates
Canada has the highest level of acute care bed occupancy in the developed world and has one of the highest rates of health care acquired infections (“HAIs” e.g. C. Difficile or MRSA) in the developed world according to World Health Organization data. The only country reported to have a higher level of health care acquired infections is New Zealand - -which also has a very low number of hospital beds per capita.
Bed cuts and high hospital bed occupancy has been associated with
• intense pressure to move patients out of hospitals, often to inappropriate for-profit retirement homes, or by threatening patients with very high fees.
• cancelled surgeries,
• backlogs in emergency rooms,
• ambulance offload delays,
• fewer ambulances available to respond to emergencies
• extra costs for municipal providers of ambulance services,
• delays in treatment and diagnosis,
• a high number of patients waiting in hospital beds for more appropriate hospital services,
• attempts by advocates of privatization to move public hospital services to for-profit provide.