Factors associated with changes in occupancy rates of California short-term hospitals: an analysis of statewide hospital discharge data.

Decline in per cent occupancy of California short-term hospitals between 1969 and 1972 was due principally to an increase in bed supply that exceeded population growth. A lesser contributory cause--decline in utilization--was due entirely to decreases in length-of-stay. Analysis of data from Statewide one-week discharge surveys, carried out in 1968 and 1970, indicates the decrease in average stay was largely centered in Medicare and Medi-Cal (Medicaid) pay classes. Admissions, however, did not decrease. These declines in stay predated the introduction of special increased restrictions on access to medical care into the Medi-Cal program in April 1970. Principal results of the study indicate that in California, government supervision of payment for hospital care has operated to reduce length-of-stay, but thus far does not seem to have affected admission rates. Insofar as these results may hold for other States, they seem to implay certain conditions that may be expected to occur with an extension of National Health insurance to the general population. Chief among these is a further depression of occupancy ratios if bed supply is held constant or increases relative to population. They also imply that further substantial reduction in hospital utilization under Medicare and Medicaid must be sought in admission rates rather than length-of-stay.