Dramatic effects on Norway's health service

Oct 15 2009

If we continue to use our hospitals in the same way as we do now, the health service in 2030 will need to employ every second young person in the country and increase hospital bed capacity by 5000.

Recent estimates made by SINTEF hospital researchers indicate that the "flood" of elderly people, which will make itself seriously felt in 2016 - 2017, will have dramatic effects on Norway's health service if we continue to be admitted to hospital as often and to stay there as long as we do today.

Impossible in practice

Senior scientist Stein Ø. Petersen of SINTEF Technology and Society calculated the figures. Together with his colleague, hospital planning expert Asmund Myrbostad, he emphasises that in practice, it will be impossible to increase hospital bed capacity by 5000 in 20 years, because we have neither the time nor a sufficiently large work-force to do so.

Measure could reduce the need

The researchers point out that a number of measures could be used to reduce bed occupancy and the number of admissions, and that some of them already form part of the government's programme for coordinated health service reform.

"But even getting patients out of hospital more quickly than we do today doesn't mean that they will suddenly become healthy. Someone will have to look after them when they have been discharged, and that will require a work-force of quite other dimensions than we employ now", says Petersen.

More elderly people and fewer in work

SINTEF's calculations are based on how much we used general hospitals (i.e. the hospital sector less the psychiatric hospitals) in 2008.

When the need for beds is estimated to be so high in 2030, this is due to the fact that we will have far more elderly people than we have today, and that the elderly are admitted more often, and remain in hospital longer, than younger people. At the same time, there will be fewer people in the active work-force to look after them and treat them during the rest of this century.

According to the government's white paper on health service coordination, in 2000 Norway had 190,000 inhabitants aged 80 or more. In 2030, the figure will be 320,000, and by 2050 it will have risen to 500,000!

According to the white paper, the ratio of people of working age to elderly people will be 3.5:1 in 2030 and 2.9:1 in 2050, compared to 4.7:1 in 2000.

Every second young person

Five thousand new hospital beds is equivalent to building six or seven new large hospitals.

"For Norway to be able to develop its hospital capacity to such an extent, planning would have to have started long ago. Nor has the country a work-force that would be capable of staffing so many beds. Between 40 and 50 percent of each leaving class of newly educated young people would have to work in the health sector if hospitals were to have 5000 new beds in 2030, proportion that is quite impossible", say Petersen and Myrbostad.

Hospital stays in focus

According to the researchers, recent surveys suggest that some hospitals have vacant beds, while others would find it impossible to increase occupancy rates.

The question of how many beds the hospital sector will need in the future depends first and foremost on how long the average stay will be, Today, the average stay is 4.7 days.

Petersen and Myrbostad says that lengths of stay vary widely from one hospital to another, and that in general they are longer than in Denmark, for example. They believe therefore that there is potential for improvement here.

"But estimating by how much it would be realistic to reduce the length of stay is a matter of pure speculation", they say.

More elderly patients raise length of stay

Since 2000, the average length of stay has fallen by about one day. During this period, the number of elderly persons in Norway has been stable.

Stein Ø, Petersen says that the growth in the number of old people itself increases the average length of stay. If each age group remains in hospital in 2030 as they did in 2008, the "flood" of old people alone would raise this figure by 0.2 days.

"And if we are to manage with the number of beds that we have today, the average length of stay will have to fall by a day and a half", he says.

The scientists' list of measure

SINTEF's Myrbostad and Petersen have drawn up a list of measures that could reduce the number of hospital admissions and lengths of stay:

• Even more elderly patients who are capable of being discharged from hospital should be transferred to local authority nursing homes or to home-based care services.

• Primary health-care doctors will have to become better at not prescribing unnecessary admissions.

• The amount of out-patient treatment by hospitals will need to be increased.

• Better hospital planning can reduce length of stay, e.g. by reducing the time spent in bed before operations.

Still a great need for manpower

"Nevertheless, some of these solutions will require more manpower in the health sector, even if they do not make such great demands on care provision as hospital wards", emphasise Petersen and Myrbostad. The two identify several measures that could help to meet the need for more manpower: a move from part-time to full-time jobs; enabling staff to retire later, and motivational campaigns to encourage young people to work in the health services.

"It may also become necessary for patients' families to help look after elderly patients who are nearly well, and whom  society cannot take care of. We should not ignore the possibility that it will not only be children's illnesses that give us the right to sick-care leave in the future", says Petersen.

Poorer services could be the outcome

The two hospital researchers also point to the danger that we will have to put up with poorer hospital services in 20 years than those we enjoy now.

"It is not impossible that the threshold for admission to hospital will be higher than we have been used to. We also risk ending up with health services that are determined by social class, in which patients who are comfortably off purchase private hospital services that other patients cannot afford", says senior scientist Stein Ø. Petersen.