Latest news with #hospitalbeds
Forbes
03-06-2025
- Business
- Forbes
Why Do We Care How Much We Spend On Medicaid?
The U.S. has fewer hospital beds per person than Europe does. In evaluating the success of Obamacare in general and Medicaid expansion in particular, reporters and commentators have tended to focus on only one measure: the increase in the number of people with health insurance. At the same time, in evaluating the health consequences of the House Republican reconciliation measure, almost all the focus has been on the number of people who will lose health insurance. The implicit premise in all of this is: more health insurance means more health care and less health insurance means less health care. That has been the premise behind virtually every important piece of health care legislation going all the way back to the creation of Medicare and Medicaid in1965. Yet the premise ignores a fundamental economic principle: no matter what happens to the demand for care, there won't be a change in health care delivered unless there is a change in supply. Under Obamacare, we are certainly spending more money. The annual cost of Medicaid expansion is $130 billion and the cost of exchange subsidies is more than $60 billion. What are we getting in return for all this extra spending? Although there has been a substantial increase in the number of people with health insurance, one study finds that there has been no overall increase in health care. In fact, the nation may be getting less care. In 2023, 13 years after the passage of the Affordable Care Act (Obamacare), the number of hospital admissions per capita was 19 percent lower and the number of hospital days was18 percent lower than the year the act was passed. In the 9 years following the passage of Obamacare, doctor visits per capita declined by 18%. Further, our health care resources appear to be quite skimpy in comparison to other developed countries. Today, the United States has 2.7 doctors per 1,000 people, while the European average is 4.1. The U.S. has fewer than three hospital beds per 1,000 residents. The EU has more than five. And our country doesn't seem to be getting any healthier. Life expectancy in 2024 was lower than it was ten years earlier. As for Medicaid, numerous studies through the years have produced conflicting results on what difference the program makes for enrollee health. Yet these studies suffer from all the problems that are inherent in making inferences from population statistics. One study was different. The Oregon Health Insurance Experiment was a randomized controlled trial (RCT) that examined the medical condition of real people. Medicaid enrollees were selected by lottery and after two years the investigators compared the medical condition of those who enrolled with those who didn't. The results: enrollees had less financial stress and were less likely to be depressed, but there was no difference in their physical health. One of the Oregon investigators, MIT economist Amy Finkelstein, helps us understand those results. People without health insurance, she notes, still get about 80 percent of the health care that Medicaid enrollees get. And when they are confronted with high medical bills, they actually pay only a small portion of them. You might suppose that Medicaid enrollees are less likely to rely on hospital emergency rooms. The reverse is true. Once they enroll, Medicaid patients increase their trips to the emergency room by 40 percent. This may explain why Medicaid enrollees place a very low value on enrollment. If you were to offer to buy their Medicaid insurance coverage, it appears that the average enrollee would sell her insurance for as little as 20 cents on the dollar. Moreover, among the lottery winners who were offered enrollment in Oregon, more than half turned the offer down! By implication, these folks placed no value on the opportunity to enroll. These findings have convinced Finkelstein (certainly no right-winger) that rather than giving low-income families more Medicaid, we should give them cash instead. Here is one way to do that. Private companies managing Medicaid (or the state itself) should be able to make deposits to Health Savings Accounts (HSAs) that would cover, say, all primary care. Enrollees would be restricted to using the money for health care during an insurance year. With these funds, they would be able to pay market prices (instead of Medicaid fees) at doctor's offices, walk-in clinics and urgent care centers – allowing them to buy medical care the way they buy food with food stamps. This would allow low-income families to have the same health care opportunities that middle-income families have. At the end of the insurance period, they could withdraw any unspent funds for any purpose. If there were no taxes or penalties for non-medical withdrawals, health care and non-health care would be trading against each other on a level playing field under the tax law. People wouldn't spend a dollar on health care unless they got a dollar's worth of value. An early study by the RAND Corporation suggests that these accounts could reduce Medicaid spending by 30 percent. Excluding payments for the disabled and nursing home care, the savings would amount to almost $1 trillion over ten years. This saving would be shared by the beneficiaries and the taxpayers who fund Medicaid. This is one way to resolve the impasse in the Senate over the House reconciliation bill. HSAs for Medicaid are a way to make the program better for enrollees and cut spending at the same time.
Sky News
03-06-2025
- General
- Sky News
'Breaking point' as people in last 12 months of life occupy 'almost a fifth of Welsh hospital beds'
People in the last 12 months of their life occupy "almost a fifth of Welsh hospital beds", according to a end of life care charity. Marie Curie Cymru says end of life care in Wales is "at breaking point" and is calling on the next Welsh government to ensure high-quality care. The charity says that, for many, support could be better provided at home or close to home, as it launched its manifesto for next year's Senedd election at Cardiff Bay's Norwegian Church on Tuesday. Gareth Miles died at home in Llanddarog, Carmarthenshire, in September 2023. Mr Miles, who had Parkinson's disease, had spent 10 weeks in hospital before his last week. His daughters, Branwen, Eiry and Elen, are calling for better care at home for those who have a palliative or end-of-life care condition. "Once [her father] was in hospital, even though he was better after 10 days, he couldn't be discharged because he lost the care package," she said. "He was being supported by carers twice a day because of his Parkinson's and his arthritis, and without the carers, we would have been unable to care for him ourselves. "So he spent a long time in hospital, waiting for a care package to be reinstated and, while he was there, his condition deteriorated." While calling for "better links" between health and social care, Mrs Miles said the support from Marie Curie was "invaluable". "Without their support, my father would have been stuck in hospital and his death would have been very painful for all of us, in quite a distressing environment," she added. 'Surrounded by his family' Remembering her father fondly, she said he was a "great person" with a "very fulfilling life". "He saw himself as a very lucky man because, as well as being able to do a job that he loved, he also had family and friends that loved him," she added. "So it was just very sad then that he spent the end of his life in those circumstances. "But luckily, we were able to bring him home and he had what he would call a good death in the end, surrounded by his family. "My intention through sharing this just to hopefully raise awareness of the issue and hopefully make sure that other people are aware of the support that they have." Natasha Davies, senior policy manager for Marie Curie Cymru, told Sky News the palliative and end of life care system in Wales was at "breaking point" and "under immense pressure". "The result of that is that too many people are not able to access the care and the support that they need, when they need it, where they need it," she said. "I think what those experiences show us is the profound impact that getting this right can have, not just on the person who's terminally ill, but also on those close to them." Ms Davies acknowledged hospital would be "the right and best place" for some people to receive their care. "But for others, we know that those hospital admissions, particularly via emergency department, could be reduced or avoided," she added. The Welsh government said: "Good palliative and end of life care can make a huge difference to those with life-limiting illness, helping them to die with dignity, and help the grieving process for those left behind. "We provide more than £16m a year to make sure everyone has access to the best possible end of life care. This includes setting national standards, boosting community services and ensuring people receive the support they need. "We are working with health boards and local authorities, supported by monthly discharge data, to improve the safe discharge of patients from hospital. This applies equally to people requiring end of life care."
BBC News
03-06-2025
- Business
- BBC News
Somerset community hospital beds could close as trust reviews services
The number of inpatient beds at two community hospitals could be cut by a third if proposals go ahead. Somerset NHS Foundation Trust has confirmed it is in the "very early" stages of a consultation to reduce beds at Frome Community Hospital from 24 to 16, with a similar number of beds under threat at West Mendip Hospital in trust said it was looking at the "mix and balance" of its community services after an "increase" in people being cared for at MP for Frome and East Somerset Anna Sabine has set up a petition to stop what she described as "short-sighted" proposals, which she claimed could also see a number of job cuts. Ms Sabine, who has launched the petition alongside councillor for Frome North Adam Boyden, claimed the closures were being proposed because too few patients were being discharged from Bath's Royal United Hospital (RUH) to she said that when she toured the RUH - which is run by a different NHS authority to Frome - she was told their main problem is that they do not have suitable places to discharge patients into."We know the Royal United Hospitals struggle to discharge people and yet we're closing beds which would help this," she Sabine said she is concerned that there is "a lack of joined up discussion" between Somerset NHS and the RUH. 'Well thought out plan' However the MP for Glastonbury and Somerton, Sarah Dyke, whose constituency includes West Mendip Hospital, has given the proposals a cautious said while she understood residents might be "concerned" at the planned bed closures, after an urgent meeting with the hospital trust's chief executive last week she believed the "overall direction of movement" was "the right one"."He has reassured me that this isn't a cost cutting exercise, but part of a well thought out strategic plan to shift reliance on community beds, moving the balance of care back to the home. But only when people are well enough to leave acute care within the hospital setting."She added that she understands "the funds and staff previously used for community hospital beds will be redeployed to make sure there are enough services in the community to facilitate this shift". But Ms Sabine said while Somerset NHS Foundation Trust has promised more services at community hospitals across the county - this is not necessarily for Frome. "We suffer a little bit from being on the edge of Somerset and working with a hospital that is not in control by the same organisation and therefore we haven't had that guarantee," she said."It worries me that this is another example of Frome being short changed."She said the "short-sighted" approach to reduce beds in Frome did not take into account the difficulty people have getting to the RUH by public transport."Our hospitals don't need fewer beds, they need proper investment," she added. Somerset NHS Foundation Trust told the BBC the proposal aims to "ensure" community care is offered "in the most appropriate setting".A spokesperson said there has been an increase in people receiving care at home in recent years as well as "significant investment" in services to support patients at home following an acute hospital admission."We are therefore looking at the range, mix and balance of NHS services that are provided in people's own homes, community hospital services and community hospital beds," they said."As a result, we are adjusting the number of beds that we are providing in some community hospitals to better match the demand, which includes a proposed reduction of eight beds at Frome Community Hospital, from 24 to 16."Alongside this, we are also looking at what other services we could provide in our community hospital settings, that are currently provided in the two main acute hospitals as we look to provide services more locally where it makes sense and is feasible to do so."Royal United Hospitals Bath NHS Foundation Trust has been approached for comment.
Japan Times
30-05-2025
- Business
- Japan Times
LDP-Komeito, Nippon Ishin agree to phase out redundant hospital beds
The ruling Liberal Democratic Party-Komeito coalition and opposition Nippon Ishin no Kai agreed Thursday to remove up to 110,000 redundant hospital beds across the country in an effort to reduce social security costs. The three parties will formalize the agreement soon with the aim of including the reduction in the government's upcoming economic and fiscal policy guidelines, which will be adopted in June. Nippon Ishin estimates that removing 110,000 hospital beds would save around ¥1 trillion ($6.9 billion) in medical costs. "The three parties share the same recognition (about the effect of reducing hospital beds)," Ryohei Iwatani, Nippon Ishin's secretary-general, told reporters after meeting with officials from the LDP and Komeito earlier on Thursday. "We have reached an agreement (on the reduction of hospital beds)," former health minister Norihisa Tamura of the LDP said. "It doesn't make sense to maintain unnecessary beds." The three parties also agreed to raise the adoption rate of electronic medical records to 100% within the next five years. Meanwhile, they will continue talks on Nippon Ishin's proposal to stop health insurance coverage for drugs containing elements similar to over-the-counter medicines.
The Independent
14-05-2025
- Health
- The Independent
Hundreds of A&E patients needlessly die every week while waiting for hospital beds
Around 320 patients a week may have died avoidably in England last year due to excessive waits for hospital beds in Accident and Emergency departments. The Royal College of Emergency Medicine (RCEM) estimates more than 16,600 deaths were linked to these delays, a sobering increase of 20 per cent compared to 2023. Dr Adrian Boyle, president of the RCEM, described the figures as "the equivalent of two aeroplanes crashing every week," highlighting the devastating impact on families. He will present these findings at the launch of the All-Party Parliamentary Group (APPG) on Emergency Care, underscoring the urgent need for action to address this critical issue. 'I am at a loss as how to adequately describe the scale of this figure', Dr Boyle remarked. 'To give it some context, it is the equivalent of two aeroplanes crashing every week. 'It's sobering, heartbreaking, devastating and more. Because this is so much more than just data and statistics. 'Each number represents a person – a dearly loved family member, grandparents, parents, siblings and friends – who has died because of a system in crisis. 'These were patients who were stuck in emergency departments, watching the clock tick by as they waited extremely long hours, often on a trolley in a corridor, for an in-patient bed to become available for them.' All-Party Parliamentary Group (APPG) on Emergency Care, chaired by Labour MP Dr Rosena Allin-Khan, an A&E doctor, has said it will look first at the harm caused to patients by delays and 'corridor care'. Last year, more than 1.7 million patients waited 12 hours or more to be admitted, discharged or transferred from A&E. Of these, 69.2 per cent were waiting to be admitted to a ward for further care, the RCEM said. For its excess death estimates, the RCEM uses a study of more than five million NHS patients published in the Emergency Medicine Journal (EMJ) in 2021. This found there was one excess death for every 72 patients that spent eight to 12 hours in an A&E department prior to being found a bed. The risk of death started to increase after five hours and got worse with longer waiting times. Using this method, RCEM estimates there were 16,644 excess deaths in 2024 related to stays of 12 hours or more. This is the equivalent of 320 lives lost every week and up 20 per cent on the 13, 919 the previous year. Dr Boyle said the methodology only applies to one group of NHS patients and 'we know there may well be many more tragic deaths linked to long stays.' He added: 'For example, patients left waiting for urgent medical care in the community because ambulances can't safely hand over their patients in emergency departments because they are full, or those too anxious to seek help with they should. 'The issue also affects A&E staff who are trying their best to deliver care in areas that are designed to be throughfares – not treatment spaces. 'Ultimately, the emergency care crisis is fixable. It's all about flow – getting patients into to a ward bed when they need one and home again as soon as they are well enough to leave. 'How best to do this, will be considered by the APPG and we look forward to working with the MPs and peers who have joined as members to resuscitate emergency care.' Dr Boyle will tell the launch event that almost half a million (478,901) patients waited more than 24 hours in A&E last year – one in every 35 patients attending. He will say this is 100,410 more people compared to 2023. Dr Allin-Khan said: 'These statistics make for sobering reading. Ever-increasing numbers of excess deaths and long wait times in our emergency departments are simply not sustainable. 'As an emergency doctor, I know exactly how stretched our A&Es across the country are, as I see it on a weekly basis on my shifts. 'The Government have pledged to fix the foundations of our public services and our A&Es must be at the front and centre of this ambition. 'There has never been an APPG for Emergency Care before and this is exactly the vehicle needed to bring together industry experts, legislators and the Government to move things forward. 'I look forward to working with RCEM and the Government constructively to bring these numbers down, ensuring everyone receives the best quality care, with the dignity they deserve.' Dr Nick Murch, president of the Society for Acute Medicine, said the figures represented a 'profound failure within our healthcare system', adding: 'It is simply shocking to see such a large number of deaths associated with excess waits in emergency departments, but, tragically, the warning signs have been present for far too long. 'We must ensure that 12-hour waits in emergency departments again become an infrequent exception rather than the norm and that will require urgent and adequate action on workforce and capacity issues which remain unresolved.' A Department of Health and Social Care spokesperson said: 'This report lays bare the crisis in NHS waiting times we inherited, with patients suffering unacceptable delays for urgent treatment. It will be a long road to fix our NHS, but we are doing the work to get us there. 'It's why we are investing an extra £26 billion to reform the health service and make it fit for the future through our plan for change. 'This includes shifting services from hospital to community to ease pressure on A&E departments, on top of recruiting an extra 1,000 GPs to reach patients earlier and move towards prevention.'
