Abstract
BackgroundRoemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?”MethodsWe employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions.ResultsWe find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis.ConclusionsThis study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in controlling hospital utilization is justified.
Highlights
Roemer’s Law famously and states, hospital beds that are built tend to be used [1]
Alexander et al controlled for temporal autocorrelation in their regression models, neither study acknowledged the spatial structure of their observations, likely misspecifying their regression models
Considering that metropolitan Detroit is one of the most segregated cities in the USA [83] and a large proportion of Michigan’s Black population resides in this region, our findings suggest that a more detailed analysis exploring the effects of race, segregation, and neighborhoods on hospital utilization rates in southeast Michigan is warranted
Summary
Roemer’s Law famously and states, hospital beds that are built tend to be used [1]. Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, ‘‘Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?’’
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