Hospital Services Vary Widely Across U.S.



WASHINGTON (ASRN.ORG)- The supply of doctors and hospital beds varies wildly across the United States and often has nothing to do with how much care patients want or need.

Affluent communities tend to have too many doctors, the survey showed -- in part because physicians tend to settle near the large teaching hospitals where they trained.

But some rural areas have far more beds per capita than other, more heavily populated areas, the Dartmouth Atlas Project found.

For the study, the nonprofit group used 306 nationwide regions and data from the government, the American Medical Association and the American Hospital Association.

The Dartmouth Atlas provides information and analysis about hospitals, doctors and healthcare markets.

It found San Francisco, an area loaded with medical schools and affluent residents, had 117 primary care doctors per 100,000 residents. Washington had 102 per 100,000.

Tiny and impoverished McAllen, Texas, had just 45.1 doctors per 100,000 residents, and El Paso, Texas, had 47.2.

The opposite pattern was seen with hospital beds, according to the study.

Newark, New Jersey, a populated urban area, lost more than a third of its hospital beds over the 10 years, while the number of beds in McAllen grew by more than 40 percent.

The affluent San Francisco suburb of San Mateo had 1.45 hospital beds per 1,000 residents in 2006, while Mississippi's Jackson and Gulfport both had 4.44 beds per 1,000.

Overall, the number of U.S. hospital beds fell by nearly 13 percent from 1996 to 2006, with a trend toward treating patients as outpatients.

But average hospital staffing rose by more than 6 percent, with a 14-percent increase in the number of registered nurses, the survey found.

Dr. David Goodman, a professor of pediatrics and community and family medicine at The Dartmouth Institution, said the numbers did not reflect need or demand.

"While high hospital and physician capacity drives costs upwards, there are many regions that do well with many fewer beds and physicians per capita. Health systems in these lower capacity regions show that efficiency is a partner, not a competitor, of quality," he said in a statement.

Goodman said Congress should require the federal Centers for Medicare and Medicaid Services to use its payment policies to try to limit hospital growth in regions that have too many beds.

The government, which is considering national healthcare reform, also should set up a national commission to direct training dollars to high-need specialties such as primary care physicians, Goodman said.

The Dartmouth Atlas Project advocates emulating organized networks of care to lower costs and boost efficiency.


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