The Bed Crises Affecting European General Hospitals

The Bed Crises Affecting European General Hospitals
Mia Española
11 July 2024
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European general hospitals face growing challenges in managing and providing enough hospital beds, with many countries struggling with shortages and capacity problems. Over the past decade, the European Union (EU) has witnessed a consistent decline in the number of hospital beds. Between 2011 and 2021, the total count of hospital beds in EU general hospitals decreased by 6.2%. 


This reduction is attributed to various factors, including cuts to healthcare spending following the global financial crisis, medical and technological advancements, changes in healthcare policies, increased focus on day care and outpatient services, and shorter average hospital stays.


While most countries saw a reduction, some experienced increases between 2011 and 2021:

Ireland: 21.3% increase
Malta: 17.8% increase
Bulgaria: 15% increase
Romania: 5.2% increase
Portugal: 1.8% increase

Finland: Largest contraction, with a 47.5% decrease between 2011 and 2020



Current State of Hospital Beds in Europe



According to data from the Organisation for Economic Co-operation and Development (OECD), the average number of hospital beds per 1,000 population in the European Union (EU) decreased from 6.9 in 2000 to 5.0 in 2018.

This average, however, hides major differences between countries. The latest full data set from Eurostat, the European Union's statistical office, offers a more detailed info:


From 2009 to 2019, hospital beds per 100,000 people in the EU-27 fell from 569.2 to 532.4, a 6.5% reduction over a decade.
Germany led the EU with 800.2 hospital beds per 100,000 residents in 2019.
Bulgaria came second, with 760.6 beds per 100,000 inhabitants.
Austria ranked third, providing 719.5 beds per 100,000 inhabitants.
Sweden had one of the lowest rates, with just 204.5 beds per 100,000 inhabitants.
Denmark reported the EU's lowest rate at 253.6 beds per 100,000 inhabitants.


And looking at curative care beds, which are vital for treating acute conditions and emergencies, the data reveals:


The EU average for curative care beds per 100,000 inhabitants was 389.8 in 2019.
Germany led with 602.3 curative care beds per 100,000 inhabitants.
Bulgaria (616.1) and Austria (545.0) also maintained high rates.
Sweden (203.9) and Denmark (249.4) had the lowest rates among EU countries.


Furthermore, between 2009 and 2019, the number of hospital beds per 100,000 inhabitants decreased in 24 of the 27 EU member states. The largest reductions were observed in Finland (-30.8%), Denmark (-26.3%), and Sweden (-22.0%). Only Romania (+6.5%), Bulgaria (+5.9%), and Malta (+1.6%) reported increases in hospital bed rates during this period.


A lack of hospital beds, along with crowded emergency departments, has been linked to higher death rates in some areas. A Swedish study looking at over four million visits to 14 emergency departments found that in Stockholm, 125 deaths that might have been prevented were connected to overcrowded emergency rooms between 2012 and 2016. This mix of bed shortages and packed emergency departments was especially risky for very ill patients needing admission.


When looking at possible causes that affect and impact the general hospital bed management systems, most hospital administrators will face.


1. Aging populations


As the European population ages, the demand for healthcare services, particularly for chronic conditions requiring long-term care, is increasing. Eurostat projections suggest that the proportion of people aged 65 and over in the EU-27 will increase from 20.3% in 2019 to 29.4% by 2050. This population change is anticipated to increase the prevalence of chronic diseases and multi-morbidity, thereby exerting additional pressure on hospital resources.


2. Budget constraints


Many European countries have implemented austerity measures in response to economic challenges, resulting in reduced healthcare spending and hospital closures. According to OECD data, average health spending growth in EU countries slowed significantly in the years following the 2008 financial crisis, declining from 4.7% per year between 2000 and 2009 to 0.7% between 2009 and 2013.

3. Shift towards outpatient care


Advancements in medical technology and a focus on cost-effectiveness have resulted in a shift from inpatient to outpatient care for many procedures. According to Eurostat data, the number of day surgery cases increased by 12% between 2010 and 2018 across EU countries.

4. Inefficient use of existing beds


Some hospitals struggle with bed management, leading to longer patient stays and reduced bed availability.


There is an outgrowing concern regarding hospital beds in the general hospital setup. Patients often face longer wait times for elective surgeries and non-emergency procedures. In the UK, the number of patients waiting more than 18 weeks for elective surgery increased from 190,000 in March 2013 to over 1.6 million in February 2020, according to NHS England data.


At the same times, Emergency departments are overcrowding day by day. With fewer available beds, emergency departments become overcrowded, leading to longer wait times and potentially compromised care quality. A study published in the International Journal of Emergency Medicine found that ED crowding was associated with a 2.5% increase in mortality rates and a 0.8% increase in 30-day readmissions.


Furthermore, there is a growing trend on delayed admissions. Some patients who require hospitalization may have their admissions delayed due to lack of available beds. In France, a 2019 report by the French Court of Auditors revealed that 27% of patients waited more than 8 hours for a hospital bed after being admitted through the emergency department. 


Staff members often also face increased workloads and stress due to the high demand for limited bed space. A survey by the European Federation of Nurses Associations in 2019 found that 45% of nurses reported leaving or considering leaving their profession due to burnout and stress, partly attributed to increased workloads from bed shortages.



Case Studies: Hospital Bed Crises in European Countries


United Kingdom


The National Health Service (NHS) in England has seen a significant reduction in hospital beds over the past decade. According to NHS England statistics:


• The number of general and acute beds fell from 110,568 in 2010/11 to 96,998 in 2019/20, a 12.3% decrease.
• Bed occupancy rates regularly exceeded 90% in recent years, peaking at 93.5% in Q3 2019/20.
• The COVID-19 pandemic exacerbated these issues, with 32% of acute trusts reporting 100% bed occupancy in January 2021.





Italy's healthcare system was severely strained during the early stages of the COVID-19 pandemic, partly due to its low number of hospital beds:


• With 3.2 hospital beds per 1,000 population in 2019, Italy had one of the lowest rates among large Western European countries.
• Intensive Care Unit (ICU) bed capacity had to be rapidly increased by 75% during the first wave of the pandemic.
• A study in the Journal of Critical Care found that regions with lower pre-pandemic ICU bed capacities experienced higher COVID-19 mortality rates.





Despite having the highest number of hospital beds per capita in the EU, Germany faces its own challenges:


• The number of hospitals in Germany decreased from 2,242 in 2000 to 1,914 in 2019, according to the German Federal Statistical Office.
• Despite this reduction, Germany maintained a high bed capacity of 8.0 beds per 1,000 population in 2019.
• This high capacity helped Germany manage the COVID-19 pandemic more effectively than many of its European counterparts.





Despite having one of the lowest hospital bed rates in Europe (2.1 per 1,000 population in 2018), Sweden has pursued a policy of reducing hospital beds in favor of community-based care. However, this approach has led to challenges, particularly during peak demand periods and the COVID-19 pandemic.


Strategies to Address Hospital Bed Shortages



Increasing capacity


Some countries are investing in new hospitals or expanding existing facilities to increase bed capacity. France announced a plan in 2021 to create 4,000 new ICU beds by 2025, increasing capacity by 50%. The UK government pledged to build 40 new hospitals by 2030 as part of its Health Infrastructure Plan.


Improving efficiency


Hospitals are implementing better bed management systems and reducing unnecessary admissions and length of stays. A study in the BMJ Quality & Safety journal found that implementing an electronic bed management system in a large UK hospital reduced bed turnaround times by 21%.


Enhancing community and home-based care


Many countries are strengthening primary care and home health services to reduce the need for hospital admissions. The Netherlands has successfully reduced hospital admissions for chronic conditions by 25% through its "Hospital at Home" program.


Adopting telemedicine


Remote consultations and monitoring can help manage some conditions without requiring hospital admission. In Germany, the use of telemedicine consultations increased by 900% during the first half of 2020, according to the National Association of Statutory Health Insurance Physicians.


Workforce development


Efforts to recruit and retain healthcare workers can help maximize the use of existing bed capacity. The European Commission launched the "EU4Health" program in 2021, allocating €5.1 billion to strengthen health systems, including measures to address workforce shortages.


Cross-border cooperation & Investing in preventive care


Some European countries are exploring agreements to share hospital capacity during peak demand periods.Focusing on disease prevention and health promotion can reduce the overall demand for hospital beds in the long term.



Can technology have a role in addressing bed shortages?



Yes, it definitely can. The current different existing systems can optimize bed allocation and predict patient flow, improving overall efficiency. A study published in NPJ Digital Medicine found that an AI-based system could predict patient discharge dates with 80% accuracy, potentially improving bed turnover rates.


Moreover wearable devices and home-based monitoring systems allow some patients to be cared for at home, freeing up hospital beds. A systematic review in the Journal of Medical Internet Research found that remote patient monitoring could reduce hospital readmissions by up to 38% for chronic heart failure patients.


With the interoperability and unification of data, EHRs bring also an improved method for data sharing can reduce duplicate tests and unnecessary admissions, streamlining patient care.

The shortage of hospital beds in Europe is a complex issue that requires multifaceted solutions. The trend towards reducing hospital beds has been driven by factors such as improved medical technologies and a shift towards outpatient care. However, the COVID-19 pandemic has exposed the vulnerabilities of healthcare systems with limited bed capacity.

Moving forward, European countries will need to strike a balance between efficiency and resilience in their healthcare systems. This will likely involve a combination of strategies, including targeted increases in bed capacity, improved bed management, enhanced community-based care, and the leveraging of technology to optimize healthcare delivery. 


Ultimately, addressing the hospital bed crisis in Europe will require sustained investment, innovative approaches, and collaboration among healthcare providers, policymakers, and technology developers. As the continent continues to face demographic changes and evolving healthcare needs, ensuring adequate hospital capacity will remain a critical challenge for years to come.






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