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Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

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  • Paul L Delamater
  • Joseph P Messina
  • Sue C Grady
  • Vince WinklerPrins
  • Ashton M Shortridge

Abstract

Background: 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. 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?” Methods: We 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. Results: We 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. Conclusions: This 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.

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  • Paul L Delamater & Joseph P Messina & Sue C Grady & Vince WinklerPrins & Ashton M Shortridge, 2013. "Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-16, February.
    • Handle: RePEc:plo:pone00:0054900
    DOI: 10.1371/journal.pone.0054900
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    as
    1. Jacob J de Vries & Peter Nijkamp & Piet Rietveld, 2009. "Exponential or Power Distance-Decay for Commuting? An Alternative Specification," Environment and Planning A, , vol. 41(2), pages 461-480, February.
    2. van Doorslaer, E.K.A. & van Vliet, R.C.J.A., 1989. ""A built bed is a filled bed?" An empirical re-examination," Social Science & Medicine, Elsevier, vol. 28(2), pages 155-164, January.
    3. Oakes, J. Michael, 2004. "The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology," Social Science & Medicine, Elsevier, vol. 58(10), pages 1929-1952, May.
    4. Grady, Sue C., 2006. "Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 63(12), pages 3013-3029, December.
    5. Clark, Jane Deane, 1990. "Variation in Michigan hospital use rates: Do physician and hospital characteristics provide the explanation?," Social Science & Medicine, Elsevier, vol. 30(1), pages 67-82, January.
    6. Gary Ferrier & Hervé Leleu & Vivian Valdmanis, 2010. "The impact of CON regulation on hospital efficiency," Health Care Management Science, Springer, vol. 13(1), pages 84-100, March.
    7. Wright, David Bradley & Ricketts III, Thomas C., 2010. "The road to efficiency? Re-examining the impact of the primary care physician workforce on health care utilization rates," Social Science & Medicine, Elsevier, vol. 70(12), pages 2006-2010, June.
    8. Guangqing Chi & Jun Zhu, 2008. "Spatial Regression Models for Demographic Analysis," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 27(1), pages 17-42, February.
    9. Jared Hewko & Karen E Smoyer-Tomic & M John Hodgson, 2002. "Measuring Neighbourhood Spatial Accessibility to Urban Amenities: Does Aggregation Error Matter?," Environment and Planning A, , vol. 34(7), pages 1185-1206, July.
    10. Li, Baibing & Martin, Elaine B. & Morris, A. Julian, 2002. "On principal component analysis in L1," Computational Statistics & Data Analysis, Elsevier, vol. 40(3), pages 471-474, September.
    11. Roger J. Marshall, 1991. "Mapping Disease and Mortality Rates Using Empirical Bayes Estimators," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 40(2), pages 283-294, June.
    12. Glenn Milligan, 1980. "An examination of the effect of six types of error perturbation on fifteen clustering algorithms," Psychometrika, Springer;The Psychometric Society, vol. 45(3), pages 325-342, September.
    13. Kroneman, Madelon & Siegers, Jacques J., 2004. "The effect of hospital bed reduction on the use of beds: A comparative study of 10 European countries," Social Science & Medicine, Elsevier, vol. 59(8), pages 1731-1740, October.
    14. Khan, Abdullah A., 1992. "An integrated approach to measuring potential spatial access to health care services," Socio-Economic Planning Sciences, Elsevier, vol. 26(4), pages 275-287, October.
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    8. Jan Bauer & David A Groneberg, 2016. "Measuring Spatial Accessibility of Health Care Providers – Introduction of a Variable Distance Decay Function within the Floating Catchment Area (FCA) Method," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-17, July.
    9. Lu, Liyong & Pan, Jay, 2019. "The association of hospital competition with inpatient costs of stroke: Evidence from China," Social Science & Medicine, Elsevier, vol. 230(C), pages 234-245.
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    11. Mitchell, Penelope & Samsel, Steven & Curtin, Kevin M. & Price, Ashleigh & Turner, Daniel & Tramp, Ryan & Hudnall, Matthew & Parton, Jason & Lewis, Dwight, 2022. "Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior," Social Science & Medicine, Elsevier, vol. 302(C).
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    14. Xuechen Xiong & Li Luo, 2020. "Inpatient Flow Distribution Patterns at Shanghai Hospitals," IJERPH, MDPI, vol. 17(7), pages 1-10, March.
    15. Dwight Lewis & Nickolas Freeman & Irem Sengul Orgut & Thera Tyner & Ryan Tramp & Niranjan Biligowda & Matthew Hudnall & Xin Thomas Yang & Thomas English & Marilyn Whitman & Steven Samsel & James Cochr, 2023. "Analytic Framework to Improve Access for a State Medicaid Agency," Interfaces, INFORMS, vol. 53(6), pages 390-407, November.
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