Descriptive Title:

Licensed hospital beds per 100,000 population and hospital bed occupancy rates

Geographic Unit of Analysis:

County and hospital

Number of Licensed Hospital Beds per 100,000 Population,
Discharges and Patient Census, by San Francisco Hospital (2010) 
Hospital Name Total # Licensed Hospital Beds Lic. Bed Occupancy Rate (%) Licensed Beds per 100,000 persons Address & Zipcode
General Acute Care (GAC)***
Total GAC California 84,629 58.4% 227  
Total GAC San Francisco 4,381 58.7% 544  
St. Francis Memorial 356 29.4% 44 900 Hyde St, 94109
SF General  598 59.5% 74 1001 Potrero Ave, 94110
St. Luke's  229 48.3% 28 3555 Cesar Chavez St, 94110
CPMC* (Davies) 254 41.7% 32 Castro & Duboce St, 94114
Kaiser (Geary) 247 67.4% 31 2425 Geary Blvd , 94115
UCSF** (Mt. Zion) 140 36.9% 17 1600 Divisadero St, 94115
CPMC* (Pacific) 313 62.5% 39 2333 Buchanan St, 94115
Laguna Honda 805 93.7% 100 375 Laguna Honda Blvd, 94116
St. Mary's 403 28.0% 50 450 Stanyan St, 94117
CPMC* (CA West) 299 31.5% 37 3700 California St, 94118
CPMC* (CA East) 101 41.2% 13 3773 Sacramento St, 94118
UCSF** (Parnassus) 582 76.9% 72 505 Parnassus Ave, 94122
Chinese Hospital  54 56.1% 7 845 Jackston St, 94133
 
Psychiatric Care (PSY)***
Total PSY California 3,058 75.8% 8  
Total PSY San Francisco 558 78.5% 69  
Jewish Home 491 85.8% 61 302 Silver Ave, 94112
Langley Porter 67 24.7% 8 401 Parnassus Ave, 94143
Source: CA Office of Statewide Health Planning and Development (OSHPD), 2010 Final Hospital Annual Utilization Data.  Accessed on May 15, 2012: http://www.oshpd.ca.gov/HID/Products/Hospitals/Utilization/Hospital_Utilization.html
* CPMC = California Pacific Medical Center.
** UCSF = University of California, San Francisco Medical Center.
*** = General Acute Care and Psychiatric Care refer to the category for which the hospital has been licensed by the state of California.  Hospitals providing general acute care may also offer psychiatric services, however their primary service is general acute care.

Why Is This An Indicator Of Health and Sustainability?

Similar to the number of physicians and nurses per 100,000 population, hospital beds per 100,000 population is an indicator of the availability of health care services and hospital capacity relative to the general population.

Hospital bed occupancy rates are a reflection of a hospital’s ability to provide safe and efficient patient care. Studies have found that occupancy rates greater than 90% are associated with increased methicillin resistant staphylococcus aureus (MRSA) infection rates. Additionally, a Canadian study found that occupancy rates exceeding 90% can increase emergency department lengths of stay and delay patients in reaching the appropriate inpatient bed. In the US, an 80-85% occupancy rate is commonly recommended; however smaller hospitals may need to maintain lower occupancy rates to accommodate admission surges.a

Interpretation and Geographic Equity Analysis

As of June 2010, there are 15 hospitals that report annual utilization data to the CA Office of Statewide Health Planning and Development (OSHPD). Thirteen of the hospitals are licensed as general acute care (GAC) facilities and two are licensed as psychiatric (PSY) facilities. San Francisco General Hospital is the only Level 1 Trauma facility in the City.

Currently, San Francisco has more than two times the number of hospital beds per 100,000 residents that the State of California as a whole for GAC hospitals and more than eight times the number of beds per 100,000 resident in psychiatric hospitals. Occupancy rates are similar when comparing San Francisco hospitals to the rate for all hospitals in California. Occupancy rates across SF hospitals vary. Because both Jewish Home and Laguna Honda are long-term care facilities, their occupancy rates are naturally higher. It has also been noted that teaching hospitals, like UCSF, often have higher occupancy rates.

According to a recent study by the Kaiser Family Foundation, community hospital capacity (excluding psychiatric hospitals) in the United States has decreased over the last thirty years as a result of shorter lengths of stay in hospitals and increased use of outpatient procedures. In the past five years, the decline has leveled off, but remains two-thirds the capacity of hospitals in 1975. (Accessed on September 29, 2009: http://www.kff.org/insurance/7031/ti2004-5-2.cfm).

Methods

We collected the number of hospital beds and their occupancy rate for each hospital that report annual utilization data to OSHPD and listed information by hospital licensure type: General Acute Care and Psychiatric.

OSHPD provides the following definitions for hospitals reporting annual utilization data (Accessed on May 15, 2012: http://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital):

“Licensed beds”:  The number of beds licensed by the California Department of Public Health, Licensing and Certification Division on the last day of the reporting period (June 30, 2010 for the period reported here). This includes beds placed in suspense. There are six licensed bed classifications: General Acute Care (GAC), Chemical Dependency Recovery Hospital, Acute Psychiatric, Skilled Nursing, Intermediate Care, and Intermediate Care/Developmentally Disabled. Within the GAC classification, there are nine sub-designations: Medical/Surgical, Perinatal, Pediatric, Intensive Care, Coronary Care, Acute Respiratory Care, Burn, Intensive Care Newborn Nursery, and Rehabilitation Care. The totals included all classifications by hospital.

“Licensed bed occupancy rate”:  This is a measurement of bed utilization during the reporting period and is calculated by dividing the reported total hospital patient census days by the respective licensed bed days.

“Licensed bed days”:  The number of licensed beds multiplied by the number of days in the reporting period. This calculation reflects changes in the actual bed capacity during the year and is used to calculate occupancy rates.

“Patient census days”:  The sum of all inpatient daily census counts (excluding nursery) for each day of the reporting period (i.e. cumulative patient census.) The reporting period is the calendar year unless the hospital was not in operation all year.

“Licensed beds per 100,000 persons”: The total number of licensed beds divided by the population living in the geographic area (805,235 from 2010 US Census for San Francisco). This indicator is frequently used to conduct international and intra-national comparisons of the availability of health care services.

Limitations

While the number of beds per 100,000 is calculated for the San Francisco population, San Francisco hospitals serve many patients who live outside of the county. Thus, this may be an over estimation of hospital capacity. Additionally, the number of beds is an aggregation of beds for different kinds of specialty care and may mask deficiencies in certain areas such as obstetrics or intensive care. Conversely, occupancy rates may underrepresent true occupancy rates because occupancy levels are reported annually and therefore do not reflect significantly higher levels that may exist for extensive periods of time due to seasonal fluctuations in hospital admissions.

Similar to other indicators, the number of hospital beds per 100,000 population is a limited indicator and changes over time must be interpreted within the context of those changes. For example, a reduction in the number of hospital beds may occur because the hospital is underfunded and/or not sufficiently reimbursed in a timely manner by state agencies or insurance companies to stay afloat economically. Or, a reduction in the number of beds may occur because the hospital's primary base population is becoming increasingly healthy and preventative and outpatient care have limited the need for inpatient care. In the first example, the hospital is not able to keep up with the demands of the community, and in the second example, the demand for hospital utilization has decreased.

Demographic shifts brought on by changing housing and economic contexts will also result in changing hospital capacity needs. Older populations tend to have longer, in patient care than younger populations. Populations without access to health insurance tend to arrive at the hospital in a more advanced stage of disease or illness progression, thus necessitating inpatient visits, than persons with health insurance. Younger populations tend to utilize obstetric and emergency room services more frequently, whereas older populations tend to utilize internal medicine, surgical and geriatric services more frequently.

Data Source

California Department of Health Services. Office of Statewide Health Planning and Development (OSHPD). Healthcare Quality and Analysis Division. Hospital Annual Utilization Data, Final 2010 Database. Accessed on May 15, 2012: http://www.oshpd.ca.gov/HID/Products/Hospitals/Utilization/Hospital_Utilization.html

San Francisco and California population estimates from 2010 US Census

Definitions Source: CA DHS. OSHPD. ALIRTS User Guides, Forms and Instructions. Instructions for Completing Annual Utilization Report of Hospitals. Report Period January 1, 2010 through December 31, 2010. Accessed on May 15, 2012: http://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital

Detailed information regarding census data, geographic units of analysis, their definitions, and their boundaries can be found in the Indicator Project at the following links:

Geographic_Units_of_Analysis

Technical Notes

  1. Keegan AD. Hospital bed occupancy: more than queuing for a bed. Med J Aust 2010; 193 (5): 291-293. & Green LV. How Many Hospital Beds? Inquiry Winter 2002/2003; 39 (4): 400-412.