Study: Hospital bed shortage looms as aging population drives demand

Editor's Note

US hospitals face a growing risk of bed shortages as an aging population drives up hospitalization rates, according to research published February 19 in Jama Network. Leveraging COVID-19-era occupancy data, the study projects national hospital occupancy could reach 85% by 2032 for adult beds and by 2035 for adult and pediatric beds combined, a level widely considered indicative of a bed shortage. This anticipated surge is primarily due to increased hospitalizations among older adults and a 16% reduction in staffed hospital beds since the COVID-19 public health emergency (PHE) ended in May 2023.

The analysis used data from nearly all US hospitals between August 2020 and April 2024, originally collected for COVID-19 tracking. It combined US Census Bureau population projections with age-adjusted hospitalization rates from the 2019-2020 National Inpatient Sample to estimate future hospital occupancy. The study assumed the length of stay would remain constant at pre-pandemic levels.

Key findings include:

• Post-pandemic occupancy spike: Mean hospital occupancy rose from 63.9% (2009-2019) to 75.3% (May 2023-April 2024), driven by a drop in staffed beds from 802,000 (2009-2019 average) to 674,000 post-PHE, while daily census remained steady at about 510,000.
• Projected demand growth: Annual hospitalizations are expected to increase from 36.2 million in 2025 to 40.2 million in 2035 due to an aging population. Without changes to hospitalization rates or bed supply, this will push national occupancy to about 85% by 2032 for adult beds.
• Regional disparities: There is substantial state-to-state variation in hospital occupancy, indicating some states are at greater risk of bed shortages than others.

Experts consider 85% occupancy a critical threshold beyond which hospitals face operational challenges and increased risk of patient mortality. Researchers write that either increasing the supply of staffed hospital beds by 10%, reducing hospitalization rates by 10%, or a combination of both could offset the anticipated demand surge. They call for further research into the causes of reduced staffed bed supply—such as healthcare labor shortages and hospital closures—and strategies to enhance health system resilience, including geographically adaptive resource distribution and innovative care models to reduce avoidable hospitalizations.