June 1999, Vol. 33, No. 4

There are currently 124 general medical surgical hospitals that provide community care to an estimated 5,402,000 Missourians. In 1983 there were 150. Twenty-six hospitals in the past fifteen years have closed, merged, and/or transited to a different service area or function. Twenty-two of these were general medical surgical facilities. Since that time, the number of hospital beds has decreased by over 7,600. Since 1983, the discharge rate has decreased from 178 discharges per 1,000 population to 132.2 per 1,000.

The information shown in Table 1 does not include state, federal, and specialty hospitals. Two state facilities, the University of Missouri Hospital and Clinics and the Missouri Rehabilitation Center, are included because the majority of their admissions are medical surgical patients. Characteristics for Missouri's general hospitals are shown in the table.

Trends to Outpatient Care
More health care services are being provided on an outpatient basis. Outpatient surgeries have steadily increased in the past 15 years. Sixty-four percent of surgeries were performed as outpatient in 1998 compared with twenty-six percent in 1983. In 1998 there were as many outpatient surgeries as inpatient surgeries in 1983. The total surgeries in Missouri hospitals in 1998 were about the same as the total hospital surgeries 15 years ago. The number of surgeries in hospitals have been affected by the past decade's growth of ambulatory surgery centers (ASCs). In 1983 there were 7 freestanding ambulatory surgery centers. Today there are 43 reporting nearly 83,000 surgical procedures.

Inpatient Utilization is Declining
The number of hospital inpatient days continues a steady downward trend. The hospital licensed-bed occupancy rate declined from 74 percent in 1983 to 44.8 percent in 1998. Missouri's staffed-bed occupancy rate of 56.7 for general medical surgical hospitals continues to be higher than the U.S. staffed-bed occupancy average of 47 percent. The following table (Graph 2) illustrates the inpatient rate decline from 1983 to the present.

Emergency Room Visits
Emergency room utilization is highest for persons under 15. The rate in 1997 for this age group was 113.6 per 1,000 persons. The rate for persons over 65 is 23.9 per 1,000 population. The uninsured population using Missouri hospital emergency rooms were 310,858 in 1997 and has not changed much in the last five years. Emergency room use rates rose at a steady rate until 1992, and then leveled off. There was a slight increase in the 1998 rate for the total population.

Reason for Change in the Number of Hospitals
Currently there are 26 fewer medical-surgical hospitals than there were in 1983. Mergers and consolidation of services have changed the number of facilities providing hospital care. In the past 15 years, these 26 have changed their services, combined with other hospitals or closed. There are currently fewer general hospitals and more specialty hospitals. Missouri has two rehabilitation hospitals, eighteen psychiatric, three long-term care, and one children's orthopedic hospital. There are three pediatric medical-surgical, and one hospital specifically for psychiatric care. Eleven closures in the past 15 years have been in rural communities. Most closures occurred in the late 1980's and early 1990's. In general, these hospitals had a small patient volume and were near another facility. Table 2 shows some characteristics of these closed hospitals.

Utilization in Missouri hospitals has been moving downward for some time. Inpatient days and average length of stay continue to decline. Changes in occupancy rates, duration of stay, and number of staffed beds is partly due to the rise in outpatient care. Managed care limits affect admitting decisions and when a patient is discharged. Even though there are more people with fewer hospitals and fewer beds, occupancy continues to decline. Ambulatory surgery centers are replacing some inpatient and outpatient surgery hospital functions. New procedures, technology, and home health care have reduced the need for longer hospital stays.

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