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We Used to Have More Hospital Beds. What Happened?

Emily Pisacreta, Host: This is Uptown Radio. I’m Emily Pisacreta. The number of COVID-19 cases in New York state has risen above 100,000 patients. Governor Andrew Cuomo said the state faces a shortage of 87,000 hospital beds. To make up for some of the missing beds, the city, state, and federal government are resorting to all kinds of solutions — turning the Javits Center into an ad hoc hospital, tents in Central Park, and even a floating, naval hospital, the USNS Comfort has anchored off of Manhattan.

But at a certain point in the 20th century, New York had many more hospital beds. Dr. Alan Sager is a professor of public health at Boston University. He’s studied hospital closures across the country, including in New York City. He says it all goes back to the 1970’s.

Dr. Alan Sager: Gradually, health care costs started to rise in the late sixties, early seventies. The Vietnam War put strain on the federal budget. And then in the 1970's we had the two oil shocks, and we had economic disruption for much of the 1970's. So the combination of rising health care costs and a shaky economy led some people to look at health care and think, we've got to rein in —slow down — the increase in rate of spending. And it looked logically like hospitals were places where expensive care happened, so let's cut back there. 

Emily Pisacreta: And that way of looking at it doesn't prepare us very well for a situation like COVID-19. Or does it? 

Dr. Alan Sager: When you think about the shape of hospital care — first: how many hospitals and how many beds. Second: what kind? Major teaching hospital, major medical center, versus medium-sized community hospital. And you're also thinking about where the hospital is located. In the United States, and this is unusual across the world, it is no one's job to think about those things. Nobody is accountable for identifying the emergency rooms or ICUs or hospitals or number of beds essential to protect the health of the public. And that's pretty remarkable. 

Emily Pisacreta: Who do you think should be accountable?

Dr. Alan Sager: Probably state government is the right level. And for metropolitan areas like Greater New York, New Jersey, Connecticut, that cross state lines, in those metropolitian areas, clearly all three states need to be involved. The only state that has developed a list of the emergency rooms and hospitals necessary to protect the health of the public is the state of Maryland, where for various reasons starting in the 1970's, the state government and hospitals got together and the state agreed to be accountable to pay only the hospitals enough money to cover the delivery of needed care, as long as it delivered efficiently. 

Emily Pisacreta: Do you expect COVID-19 to change the way we think about hospital capacity?

Dr. Alan Sager: The coronavirus disaster forces all of us to think twice. Maintaining reserve capacity by mothballing hospitals that are already built, equipped, and paid for, is much less expensive than trying to find space in hotel rooms or convention centers, which will lack necessarily negative airflow and other safety practices that you really want in case of infectious disease.

We often say that hindsight is 20/20, so knowing what we know now, what would we have done differently 6 months or a year, or 10 or 20 years ago? Can we make a list of those things and make sure that when we come out fo this crisis, we actually do those things?

Emily Pisacreta: Dr. Alan Sager, thank you for joining us on Uptown Radio.

Dr. Alan Sager: Emily, you’re very welcome.

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