eMJA: Trends in the use of hospital beds by older people in Australia: 1993

Mark Mackay,* Peter Millard^†

* PhD student, Department of Psychology, Level 4, Hughes Building, University of Adelaide, Adelaide, SA 5005, and Principal Project Officer, SA Department of Health; ^† Emeritus Professor of Geriatric Medicine, St George’s Hospital Medical School, and Visiting Professor — Health and Social Care Modelling Group, University of Westminster, London. mmbmATiprimus.com.au

To the Editor: Gray, Yeo and Duckett used the wrong basis of measure for their analysis of bed trends.1 Bed use per thousand of the population masks the trends in total bed-days or separations and does not address the issue of supply. These issues have important ramifications for policy decision-making.

Using the same sources of data,2,3 we compared bed-related statistics and population changes for the periods 1993–94 and 2001–02. What should be of most interest to planners is that the number of multi-day bed-days only declined marginally (from 14 434 to 14 231; −1.4%), despite the significant increase (from 1698 to 3343; + 96.8%) in same-day activity.

Although multi-day separations and bed-days did decline (separations, − 4.2%; bed-days, − 14.9%) for those aged 65–74 years, for those aged 75 years or over bed-days and separations increased significantly (separations, + 41.6%; bed-days, +27.7%). Furthermore, same-day activity increased significantly for those aged 65 or more years.

Furthermore, the authors failed to highlight the implications of changes in the relative age mix of activity. For those aged 75 years or more, the increase in proportion of separations (+ 5.8 percentage points) and bed-days (+ 1.8 percentage points) was greater than the increase in this proportion of the population (+ 1.1 percentage points). For the 65–74-years age group, the proportion of same-day hospital activity increased (+ 1.3 percentage points), unlike the reduction in that proportion of the population (− 0.2 percentage points).

Moreover, the question of whether an ageing population has resulted in the need for more beds can not be answered without considering the supply of beds. From our experience, the growth in same-day activity has been achieved, at least in part, by substituting same-day beds for inpatient beds. The need for increased same-day beds has been considerable. Statistics relating to same-day beds do not appear to be reported for Australia as a whole. However, the increasing implied bed occupancy (including same-day) shown in the Box supports this conclusion.

We surmise that the reduction in supply of multi-day beds combined with a marginally altered demand for multi-day beds has led to increasing numbers of bed crises. Given that relative growth in same-day activity can be attributed to people aged 65 years or over, and that the number of multi-day bed-days for those aged 75 years or more has increased, it appears that the ageing of the population, combined with the manner in which the substitution of beds has occurred, has contributed to increasing bed crises.

Changes in implied bed occupancy

	Financial year				Change from 1998–99 to 2001–02
	1998–99	1999–00	2000–01	2001–02	Change from 1998–99 to 2001–02

Total bed-day utilisation (000s)	22 323	22 597	22 467	23 218	+ 4.0%
Total available bed-days (000s)	28 868	28 540	28 675	28 787	− 0.3%
Implied occupancy	77%	79%	78%	81%	+ 4.3%

Len C Gray,* Stephen J Duckett^†

* Professor in Geriatric Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102; ^† Professor of Health Policy, Latrobe University, Melbourne, VIC lgrayATsoms.uq.edu.au

In reply: Mackay and Millard have raised some important issues in relation to our analysis. Our article was developed to encourage wider reflection and their response is thus welcomed.

The primary criticism levelled by Mackay and Millard was that we underplayed the importance of supply of beds in our interpretation of the trends. We agree that bed supply is an important driver of utilisation patterns. We acknowledged this, in part, in the discussion as a possible explanation for rising separation and declining bed-utilisation rates in the older patient population. We are also sympathetic to the hypothesis that there may be a process of substitution of same-day separations for multi-day separations.

However, data relating to bed availability are not readily available, and thus could not be included in our study. Our article was designed to highlight different trends between age groups, which have not previously been reported. Now that these trends have been identified, further research and analysis is required to fully explain them, with a view to supporting an intelligent strategy to prepare for future population ageing.