Aims: Reduction in hospital bed utilisation has been a key factor in controlling costs in recent decades in many health systems, including New Zealand's. This paper has the following aims: to analyse trends in hospital bed utilisation from 1988 to 2006; to examine variation between district health boards (DHBs); to consider factors which may explain the trends observed; to compare the results with international trends; and to discuss future need for beds and factors affecting this need, including the integrated DHB system.
Methods: Ministry of Health Hospital Throughput reports for 1988/89 to 2005/06 were accessed and present standardised, filtered, and truncated data on discharges, average length of stay (ALOS), bed days, and DHB comparisons. Data on beds were also obtained from the Private Surgical Hospitals Association. Rates of utilisation were calculated using Statistics New Zealand and the Ministry of Health population data. Australian, UK, and US comparisons were obtained.
Results: The New Zealand data showed a continuing rise in discharge rates, especially case weighted. This was almost entirely due to the increase in day patients. There was a marked downward trend in bed day rates due to a more than 50% decline in the ALOS and a corresponding decline in bed availability. There was a marked variation between DHBs in standardised discharge ratios in 2005/06, with low rates indicating potential benchmarks to which higher utilisation DHBs might aspire. New Zealand was well ahead of both Australia and the UK National Health System (NHS) in reducing bed utilisation but comparisons with Kaiser Permanente indicated that DHBs could potentially, even dramatically, reduce bed utilisation through reducing admissions.
Conclusions: The findings point to important progress in New Zealand in containing costs associated with hospital bed utilisation. Future strategies need to focus strongly on reducing hospital admissions through PHO action to provide community alternatives and chronic disease management.