Numbers of hospital beds in the EU are declining. Where is worst hit?

The COVID-19 pandemic triggered a discussion about the critical importance of hospital beds during health crises, especially as the number of available beds has declined in many European countries over the past decade.

In the EU, the average number of hospital beds fell from 563 per 100,000 people in 2012 to 516 in 2022, a decline of over 8 per cent according to Eurostat. In some countries, this decrease exceeds 15 per cent.

Experts point to several factors behind this shift, as well as the significant variation in the number of hospital beds per capita across different nations.

So, how does the number of hospital beds per 100,000 people vary across Europe and which countries reported the biggest drops in the hospital beds? 

Among 35 countries, including EU member states, candidate countries, EFTA nations and the UK, Bulgaria had the highest ratio of hospital beds relative to its population, with an average of 823 beds per 100,000 people.

Germany followed with 766 beds, and Romania ranked third with 728 beds.

Sweden recorded the lowest number of hospital beds, with just 190 beds per 100,000 people, highlighting the significant disparity across Europe.

The UK (242), the Netherlands (245), Denmark (248), Finland (261), Iceland (284), Ireland (291), and Spain (294) also had less than 300 hospital beds per 100,000 people.

Among Europe’s top five economies, France (550) ranked just behind Germany (766), while Italy (314) and Spain (294) had around 300 hospital beds per 100,000 people. The UK had the lowest rate with 242 beds. 

Why do the number of hospital beds vary significantly?

The Nordic and Southern European countries generally had fewer hospital beds per person compared to other regions in Europe.

According to Dr. Elmer Diána, senior lecturer at University of Pécs in Hungary, these huge differences can be attributed to a number of factors such as historical and health care system peculiarities.

“While Eastern European health care systems initially focused on improving the ratio of doctors and beds per patient, Western Europe prioritised the quality and development of care and acquired advanced healthcare technology systems,” she told Euronews Health. 

For instance, in explaining the low number of hospital beds in the Netherlands, Elmer Diána highlighted the country’s “efficient outpatient care and a strict primary care gatekeeper system”.

Health system differences: Role of long-term care beds

One key difference in healthcare systems is the emphasis some countries place on long-term care beds.

In addition to hospital beds, long-term care beds in nursing and other residential long-term care facilities play a crucial role. The availability of these beds also varies significantly across countries.

In 2022, the Netherlands recorded the highest number of long-term care beds, with 1,420 per 100,000 people, closely followed by Sweden, Belgium, and Malta, where the numbers ranged between 1,250 and 1,300 beds. 

The number of long-term care beds was above 1,100 in five other countries as well, including Germany, Luxembourg, Switzerland, Finland, and Slovenia.

Bulgaria (25) and Greece (26) reported the lowest numbers of long-term care beds per 100,000 people, followed by Turkey with 91 beds. 

Number of hospital beds is declining

The number of hospital beds, both in total and per person, has been declining in most European countries.

Between 2012 and 2022, the number of hospital beds in the EU dropped by more than 170,000, reflecting a 7 per cent decline over the decade.

Changes in the number of hospital beds per person offer more meaningful insights. Therefore, we focus on comparing countries based on this indicator.

In the EU, the number of hospital beds per 100,000 people decreased from 563 to 516, representing an 8 per cent decline.

Among 35 European countries, the number of hospital beds per person declined in 29 countries, while it increased in the remaining six. 

The change has been relatively slow in a few countries, with shifts of less than ±5 per cent. However, in some countries, the decline or growth in hospital beds per person has been much more significant and noteworthy.

Huge drop in Finland and the Netherlands

Finland and the Netherlands experienced the most significant declines during this period, with decreases of 51 per cent and 39 per cent, respectively.

The decline was also significant in several other countries, exceeding 20 per cent: Sweden (-29), Estonia (-24), Lithuania (-24), Iceland (-22) and  Luxembourg (-21).

The Nordic countries reported the largest declines in hospital beds per person during this period.

On the other hand, Bulgaria experienced the highest growth, with the number of hospital beds per person increasing by 25 per cent, followed by Turkey (16 per cent), Ireland (14 per cent), and Romania (10 per cent).

Among the top five European economies, the UK experienced the largest decline in hospital beds per person, with a drop of 16 per cent, followed by France (-13 per cent), Italy (-10 per cent) and Germany (-8 per cent). This was just -2 per cent in Spain. 

Possible reasons behind the decline

According to Eurostat, the EU’s official statistical office, the reduction in the hospitals beds in the EU reflects two main points.

Firstly, the data on hospital beds only covers beds for in-patient care (excluding day care and out-patient care beds)

Secondly, the scientific and technological developments which reduced the average length of stay for in-patient procedures or replaced those procedures with ones provided by day care or out-patient care.

The Organisation for Economic Co-operation and Development (OECD) also pointed out that the decline is “due in part to greater use of day care and reductions in the average length of stay”.

Looking at specific countries, Finland has focused on shifting care from inpatient to outpatient settings, according to Liina-Kaisa Tynkkynen, Chief Researcher at the Finnish Institute for Health and Welfare.

“Hospital beds have been replaced for instance by residential care for the elderly as well as centralising services to larger units,” she told Euronews Health. 

This was also the case in Sweden, where a reorganisation of certain parts of the healthcare system led to changes.

“Existing institutions and programs were transformed, and several specialised institutions providing long-term care were established,” Elmer Diána explained.

Why have some countries increased their bed capacities?

Elmer Diána emphasised the significant population growth in Ireland and Turkey over the past two decades, with increases of more than 25 per cent. 

“To meet the needs of a growing and ageing society, Ireland began to increase the number of hospital beds in several stages,” she said. 

Regarding Bulgaria, she highlighted the role of the rapid expansion of private hospital activity.

Dr Rodney Jones, Statistical Advisor for Healthcare Analysis, argued that hospital beds per population is a flawed metric for comparison, suggesting that deaths per population should also be considered.

“Indeed, the absolute number of deaths is the primary driver of bed demand with age being a secondary factor,” he added.

Is the declining number of hospital beds a risk?

Tynkkynen believes that if the resources could be transferred more towards primary care and early detection of diseases, the trend is probably beneficial.

“However, for instance COVID-19 pandemic showed that in a situation in which the need for inpatient care increases dramatically there are also some risks if we cut down the number of hospital beds too much,” she warned. 

The article, led by Diána in the Value in Health Regional Issues journal, concluded that COVID-19 pointed to how important it is to improve hospital bed capacity and to develop human resources to tackle and adequately respond to a future healthcare emergency.

“The degree that declining bed numbers poses a risk depends on the shift in funding into community-based care and the trend in the absolute number of future deaths in each country,” Jones added.