Decline in bed numbers is international: Major increase in day surgery with minimal overnight stays is at forefront of Utopian vision for health service of the future

MOST industrialised countries have experienced large falls during the past two decades in the numbers of hospital beds available, writes Jack O'Sullivan.

The US has fewer beds per capita than any other OECD country apart from Britain, according to Victor Rodwin, professor of health policy at New York University. 'The fact that beds are so expensive and there is competition between hospitals means that insurance companies have been able to push hospitals to adopt more efficient, cost-saving methods,' he said. 'Britain has controlled bed numbers . . . because of its centralised system.'

The key to reducing New York's hospital beds has lain in offering patients better primary care. In New York City the health authority closed 20 per cent of the municipal hospital beds in the 1980s, while opening new local primary health care clinics.

France has lately moved to improve its controls. A law passed in 1990 gives the Ministry of Health powers to restrict the opening of new beds.