General Hospital Beds Research Articles

Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

ObjectiveTo evaluate the length of stay difference and its economic implications between hospital patients and virtual ward patients.DesignRetrospective longitudinal study.SettingWrightington, Wigan and Leigh (WWL) Teaching Hospitals, National Health Service (NHS)...

A transformação digital no gerenciamento do fluxo de leitos nos hospitais

Abstract Purpose: This article aims to identify the benefits and difficulties managers perceive regarding implementing digital transformation (DT) in hospital bed management. Originality/value: The article contributes to academia by analyzing a rele-vant topic, DT of health, that is scarcely explored in the multifactorial perspective of its technological, organizational, and social elements. No similar study was identified with application in a large private hospital located in a developing country. By analyzing managerial perceptions about implementing DT applied to hospital bed management, the study allows a better understanding and potential strengthening of this DT process by the professionals involved, which can contribute to expanding access to hospital care. Design/methodology/approach: A single case study was carried out to investigate the implementation of DT for managing hospital beds in a private general hospital in São Paulo, Brazil. We interviewed 19 managers responsible for hospital bed management. The interviews were analyzed using two methods: content analysis and data mining, and they were classified according to their technological, organizational, and social elements (Reis et al., 2018). Findings: DT’s most cited potential benefits were efficiency gains, real-time information, and employee and patient satisfaction. The main dificulties reported were systems integration, data availability in real-time, instituting new processes, and challenges related to organizational culture and the necessary changes. DT can positively impact bed flow management, but it is crucial to consider the technological, organizational, and social elements involved in its success.

Risk of severe COVID-19 in unvaccinated patients during the period from wild-type to Omicron variant: real-world evidence from Japan.

Many studies have reported that the Omicron variant is less pathogenic than the Delta variant and the wild-type. Epidemiological evidence regarding the risk of severe COVID-19 from the wild-type to the Omicron variant has been lacking. Study participants were COVID-19 patients aged 18 and older without previous COVID-19 infection who were notified to the Nara Prefecture Chuwa Public Health Center from January 2020 to March 2023, during the periods from the wild-type to the Omicron variant. The outcome variable was severe COVID-19 (i.e., ICU admission or COVID-19-related death). The explanatory variable was SARS-CoV-2 variant type or the number of COVID-19 vaccinations. Covariates included gender, age, risk factors for aggravation, and the number of general hospital beds per population. The generalized estimating equations of negative binomial regression models were used to estimate the adjusted incidence proportion (AIP) with 95% confidence interval (CI) for severe COVID-19. Among 77,044 patients included in the analysis, 14,556 (18.9%) were unvaccinated and 520 (0.7%) developed severe COVID-19. Among unvaccinated patients, the risk of severe COVID-19 increased in the Alpha/Delta variants and decreased in the Omicron variant compared to the wild-type (AIP [95% CI] was 1.55 [1.06-2.27] in Alpha/Delta and 0.25 [0.15-0.40] in Omicron), but differed by age. Especially in patients aged ≥80, there was no significant difference in the risk of severe COVID-19 between the wild-type and the Omicron variant (AIP [95% CI] = 0.59 [0.27-1.29]). Regarding the preventive effect of vaccines, among all study participants, the number of vaccinations was significantly associated with the prevention of severe COVID-19, regardless of variant type. After stratified analyses by age, patients aged ≥80 remained a significant association for all variant types. On the other hand, the number of vaccinations had no association in Omicron BA.5 of patients aged 18-64. Patients aged ≥80 had less reduction in risk of severe COVID-19 during the Omicron variant period, and a greater preventive effect of vaccines against severe COVID-19, compared to younger people. Our findings suggest that booster vaccination is effective and necessary for older people, especially aged ≥80.

Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990-2020.

Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period. The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities. Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%). The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

Community mental health care network: an evaluative approach in a Brazilian state

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

Taiwan National Health Insurance and Proportional Physician Fee of Psychiatrist in General Hospital during the COVID-19 pandemic : Case Report

IntroductionIn Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.ObjectivesThis study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.MethodsDemographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.Results Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.Image:Image 2:Image 3:ConclusionsIn the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.Disclosure of InterestNone Declared

Estimating the Impact of Influenza Vaccination on Acute and ICU Hospital Bed Usage in an Influenza Season under Endemic COVID-19 in the US.

In 2021-2022, influenza vaccine coverage in the US dropped below pre-COVID-19 pandemic levels. Cocirculation of COVID-19 and influenza could place a substantial burden on hospital utilization in future seasons, particularly given the reduced exposure to influenza during the pandemic. We used a dynamic susceptible-exposed-infected-recovered model to simulate influenza transmission with varying influenza vaccine coverage against a background of COVID-19 circulation, in order to estimate acute and ICU hospital bed occupancy for both diseases. We evaluated two vaccine scenarios: egg-based quadrivalent influenza vaccine (QIVe) for all age groups or cell-based QIV (QIVc) for 0.5-64 year-olds with adjuvanted QIV (aQIV) for ≥65 year-olds. ICU bed availability was more limiting than general hospital bed availability, with a vaccine coverage of ≥70% required to avoid negatively impacting ICU bed availability in a high-incidence influenza season. The timing of disease peaks was a key factor together with vaccine coverage, with a difference of ≥50 days needed between peak influenza and COVID-19 bed usage together with 65% influenza vaccine coverage to avoid negative impacts. QIVc + aQIV resulted in lower bed occupancy which, while not substantial, may be critical in very high hospital resource usage situations. In a situation with co-circulating influenza and COVID-19, proactive vaccination planning could help to avert overwhelming healthcare systems in upcoming influenza seasons.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Current status of readmissions in general hospital beds at base hospitals for medical care in remote areasand examination of factors predicting readmissions

Current status of readmissions in general hospital beds at base hospitals for medical care in remote areasand examination of factors predicting readmissions

Lockdown, essential sectors, and Covid-19: Lessons from Italy

This paper investigates how economic activity impacted Covid-19 infections and all-cause mortality. To this purpose, we exploit the distribution of essential sectors, which were exempted from a national lockdown enacted in Italy during the first wave of the pandemic, across provinces and rich administrative data in a difference-in-differences framework. We find that a standard deviation increase in essential workers per built square kilometre leads to 1.1 additional daily cases and 0.32 additional daily deaths per 100,000 inhabitants. Back of the envelope calculations suggest that about one third (47,000) of the Covid-19 cases and about 13% (13,000) of deaths between March and May of 2020 can be attributed to the less stringent lockdown for these sectors. The effect is heterogeneous across sectors. Finally, we find that the local health system played a relevant role in reducing fatalities with a higher number of general practitioners and hospital beds per capita being associated with a lower mortality.

Chameleon project: a children’s end-of-life care quality improvement project

In response to there being no specialist paediatric palliative care (PPC) team in a region of England, we undertook a 12-month quality improvement project (funded by National Health Service England’s...

Assessment of Critical Care Surge Capacity During the COVID-19 Pandemic in Japan.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Gaining from rational health planning: Spatial reallocation of top-tier general hospital beds in China

The inequity in spatial access to health care among regions remains one of the most persistent challenges faced by countries around the world. This study addressed the problem of maldistribution of top-tier healthcare resources in China via the adoption of rational health planning. We proposed an optimization model to maximize the equity in spatial access by reallocating beds among currently existing top-tier general hospitals in China. The two-step floating catchment area method was employed to measure the spatial accessibility, and quadratic programming with the objective of minimizing the demand-factor-weighted variance of spatial accessibility was used to obtain the optimal quantity of beds in each hospital. The results demonstrated that the reallocation of beds had substantially improved both equity and efficiency of spatial access. The optimized spatial reallocation of beds promoted equity in spatial access with a 52% reduction of the weighted standard deviation, from 1.03 to 0.49, as well as achieving enhanced efficiency represented by a 153% increase in the weighted median spatial access, from 0.15 to 0.38. Our findings are expected to provide implications on spatial allocation of China’s healthcare resources, and the optimization method could be adopted in future evidence-based health planning procedures in order to improve the equitableness of healthcare delivery systems.

Bed Surge Capacity in Saudi Hospitals During the COVID-19 Pandemic.

To assess the hospital beds and intensive care unit (ICU) beds with a ventilator surge capacity of the health system in Kingdom of Saudi Arabia (KSA) during the coronavirus disease (COVID-19) pandemic. This study used relevant data from the National Health Emergency Operation Center to estimate general hospital and ICU bed surge capacity and tipping points under 3 distinct transmission scenarios. The study results reveal that hospitals in the KSA need to be supplied with additional 4372 hospital beds to care for COVID-19 positive cases if the pandemic continues over a 6 months' period. At the same time, it requires additional 2192 or 1461 hospital beds if the pandemic persists over a 12- or 18-month period, respectively, to manage hospitalized COVID-19 overloads. The health system surge capacity would suffer from a shortage of 1600, 797, and 540 ICU beds under the 3 transmission scenarios to absorb critical and intensive care COVID-19 cases. Our findings highlight the urgent need for additional hospital and ICU beds in the face of critical COVID-19 cases in KSA. The study recommends further assessment measures to the health system surge capacity to keep the Saudi health system prepared during the COVID-19 pandemic.

Crisis intervention for serious mental disorders. The example of the First Department of Psychiatry of Athens University

We describe the crisis management and resolution service for serious mental disorders established by the First Department of Psychiatry of the National and Kapodistrian University of Athens. The service is intended to meet patients' needs for adequate management of acute mental crisis without hospitalization, while implementing modern standards in mental care and considering existing restrictions in mental health resources and public expenditure. Last decade we witness an increase in demand for psychiatric beds in Psychiatric clinics of General Hospitals resulting in a drastic increase of auxiliary beds that becomes a serious problem in mental health provision. The shutdown of big psychiatric hospitals in the process of psychiatric reform, accompanied by a delay in the establishment of all the anticipated beds in general hospitals together with overloaded and insufficient network of mental health services in the community are the major determinants. Additionally, fiscal economic crisis of the last decade intensified even more the problem by diminishing funding for the recruitment of new personnel and drastically reducing allocated funding for new and old services. In 2016 we set up a crisis intervention service for serious mental disorders within the operational framework of the emergency psychiatric services of the Department of Psychiatry in Eginition Hospital in Athens. The crisis resolution team is composed by two psychiatrists, a psychiatric nurse, social workers, a psychologist, mental health volunteers, and mental health trainees/students. The patient enters the service through the emergency service when an indication for hospitalization is given by the emergency psychiatrist, followed by the clinical estimation of a member of our team. The therapeutic team convenes twice a week for the new entrants and for follow-up sessions with the participation of the patient and the family members whenever feasible. The rest of the therapeutic interventions take place during the week. The work 'with' the person and not 'to' the person encapsulates the philosophy of the service, which is characterized by a holistic treatment approach aiming to empower the individual strengths and sense of control of the patient for crisis resolution on the basis of a safe therapeutic milieu. Therapeutic interventions include family and supportive members, as well as community interventions. In summation, interventions consist of a) comprehensive evaluation (psychiatric/ physical) and therapeutic plan, b) psychopharmacological treatment, c) psychotherapeutic support for the patient and the family for management of the crisis, d) training for the management of future crises and e) referral to appropriate community services for follow up management and treatment. Treatment lasts approximately 6-8 weeks. Initial data of the evaluation study indicate clinical effectiveness and high levels of satisfaction for patients and family. Conclusively, crisis management and resolution services are feasible even in a time of heavy restrictions in recourses, and anticipated benefits are multiple for the economy, mental health provision, the public health system, patients and relatives alike.

Caracterização das internações nos leitos de saúde mental em hospital geral

No cenário da reforma psiquiátrica identificam-se propostas de reconfiguração do lugar e do modelo de atenção que perpassa o dispositivo da internação. Entretanto, há resistências para sua efetivação, constituindo a internação como um importante objeto de análise e reflexão. Esse artigo objetiva caracterizar as internações ocorridas nos Leitos de Saúde Mental em um Hospital Geral de um município do interior do Paraná, no período de setembro/2014 a dezembro/2017. Trata-se de um recorte analítico de uma pesquisa quanti-qualitativa com viés descritivo, sob a abordagem teórico-metodológica da Análise Institucional. Destacamos algumas potências desse serviço como o fato de encontrarem-se territorializados, com tempo médio de internação inferior a 7 dias e com baixo número de reinternações e de transferências para outros serviços.

Assessing the hospital surge capacity of the Kenyan health system in the face of the COVID-19 pandemic.

IntroductionThe COVID-19 pandemic will test the capacity of health systems worldwide and especially so in low- and middle-income countries. The objective of this study was to assess the surge capacity of the Kenyan of the Kenyan health system in terms of general hospital and ICU beds in the face of the COVID-19 pandemic.MethodsWe assumed that 2% of the Kenyan population get symptomatic infection by SARS-Cov-2 based on modelled estimates for Kenya and determined the health system surge capacity for COVID-19 under three transmission curve scenarios, 6, 12, and 18 months. We estimated four measures of hospital surge capacity namely: 1) hospital bed surge capacity 2) ICU bed surge capacity 3) Hospital bed tipping point, and 5) ICU bed tipping point. We computed this nationally and for all the 47 county governments.ResultsThe capacity of Kenyan hospitals to absorb increases in caseload due to COVID-19 is constrained by the availability of oxygen, with only 58% of hospital beds in hospitals with oxygen supply. There is substantial variation in hospital bed surge capacity across counties. For example, under the 6 months transmission scenario, the percentage of available general hospital beds that would be taken up by COVID-19 cases varied from 12% Tharaka Nithi county, to 145% in Trans Nzoia county. Kenya faces substantial gaps in ICU beds and ventilator capacity. Only 22 out of the 47 counties have at least 1 ICU unit. Kenya will need an additional 1,511 ICU beds and 1,609 ventilators (6 months transmission curve) to 374 ICU beds and 472 ventilators (18 months transmission curve) to absorb caseloads due to COVID-19.ConclusionSignificant gaps exist in Kenya’s capacity for hospitals to accommodate a potential surge in caseload due to COVID-19. Alongside efforts to slow and supress the transmission of the infection, the Kenyan government will need to implement adaptive measures and additional investments to expand the hospital surge capacity for COVID-19. Additional investments will however need to be strategically prioritized to focus on strengthening essential services first, such as oxygen availability before higher cost investments such as ICU beds and ventilators.

Argentina: A mental health system caught in transition

For the past 20 years, Argentina has been embroiled in a debate about its psychiatric asylums slated to be closed by 2020. These 19th century edifices have been the subject of serious criticism centered on human rights abuses of patients and appalling conditions of care. Legislation introduced in 2010 directed a 10-year timeline for the closure of psychiatric institutions, heralding a policy of deinstitutionalization to be completed by the imposed time limit. It looks now however, that the process is arguably at a tipping point between continued institutionalization and partial community reintegration. The law requires the reduction of patients in psychiatric institutions, the availability of psychiatry beds in general hospitals, a guarantee of patient rights, the establishment of interdisciplinary teams, day hospitals and community-based care. Although some changes have occurred in the delivery of mental health services, minimal progress has been made toward implementing a comprehensive vision for mental health. Community mental health programs are few and underdeveloped, with some notable exceptions, and the mental health system as a whole appears to be stuck in the early stages of transition. This paper reviews the historical and current mental health system in Argentina and uses interpretative phenomenological analysis (IPA) as a method for exploring the views of stakeholders, including practitioners, academics and researchers in Buenos Aires, in order to understand how they make sense of the difficulties in implementation of the 2010 law. Some key recommendations about community mental health programs emerge from the findings of the study.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

Maximum equity in access of top-tier general hospital resources in China: a spatial optimisation model

BackgroundThe health-care system in China has improved substantially, but regional disparity in the allocation of health-care resources remains a crucial problem, especially for high-quality health-care resources. We aimed to explore the reallocation of the top-tier general hospital beds to achieve higher equity of spatial accessibility in China. MethodsWe collected the supply data from the Chinese National Health Commission. 550 top-tier general hospitals in 2015 were included in our study. We obtained the population data from the WorldPop database, and aggregated to the county-level data. We used the two-step floating catchment area method to measure spatial accessibility to top-tier general hospitals. Then, we established a spatial optimisation model to minimise the variance of spatial accessibility of 2853 counties, and the quadratic programming was used to compute the optimised beds of each hospital. Finally, we compared the current and optimised spatial reallocation policy in terms of SD of spatial accessibility. FindingsThe optimised policy achieved equal spatial accessibility with lower SD from 0·592 to 0·356. The SD of spatial accessibility decreased from 0·571 to 0·322 for eastern areas, from 0·598 to 0·339 for central areas, and from 0·593 to 0·340 for western areas. However, there were substantial differences in average spatial accessibility in different areas. The average spatial accessibility for eastern areas increased from 0·52 to 0·57, whereas it decreased from 0·49 to 0·45 for central areas and from 0·36 to 0·28 for western areas. The optimised number of beds in the east was 400 521, central was 237 974, and west was 163 672. The gaps between the current and optimised results suggested that more beds needed to be allocated to the east, whereas the beds in central and western areas were oversupplied. InterpretationOur findings implied that the central and western areas need to reduce the bed supplies under the condition that the total beds remain unchanged. To promote equal accessibility, health policies should be different for different areas. More resources are needed for the east, whereas improving the road network and building more hospitals would help to improve spatial accessibility in central and western areas. FundingThe National Nature Science Foundation of China (71874116) and China Medical Board (17-276).