While there is a general consensus among economists and policy-makers that healthcare systems are wasteful and inefficient, pointing out specific sources of inefficiency can be challenging. New research focuses on a specific source of inefficiency in healthcare, commonly referred to as hospital ‘bed-blocking’.

The study shows that the provision of home-care services can reduce bed-blocking by four days without affecting the treatment received while at the hospital. The beds freed up by bed-blockers are used to admit more elective patients. 

The World Health Organization considers excessive lengths of hospital stay one of the leading sources of inefficiency in healthcare. One reason for excessive lengths of hospital stay is bed-blocking.

Bed-blocking occurs when a patient is clinically fit to be discharged but requires some support outside the hospital, which is not readily available, resulting in longer lengths of stay. These imply higher hospital costs, have potentially detrimental health impacts originating from increased risks of mobility loss, nosocomial infections, and loneliness, and can create delays for patients awaiting elective care. 

There are growing concerns about bed-blocking across developed countries. These are fueled by demographic and social trends, such as the increasing shares of elderly in the population and of individuals living with multiple comorbidities, the rise in female labor force participation and the decline of inter-generational households.

This study examines whether LTC provision reduces bed-blocking. It uses individual data on hospital admissions in Portugal and exploits the staggered rollout of the public LTC Network, which comprises nursing homes and home-care teams.

The analysis compares the length of stay of patients who exhibit social factors that put them at risk of bed-blocking (such as living alone or having inadequate housing) and the length of stay regular patients, before and after the entry of the first nursing home and the first home-care team in their region. 

There are several main findings: 

  • First, the entry of the first home-care team in a region reduces the length of stay of bed-blockers by four days, while leaving the length of stay of regular patients unchanged.
  • Second, the entry of the first nursing home in a region only reduces the length of stay of bed-blockers with high care needs, such as those with a stroke diagnosis.
  • Third, the reductions in the length of stay of bed-blockers have no impact on the treatment they receive while at the hospital, consistent with the longer length of stay of bed-blockers being unnecessary.
  • Fourth, the entry of the first home-care team in a region leads to a 2% increase in elective admissions, suggesting that the beds freed up by bed-blockers are put to an alternative use. This is relevant because waiting times for elective care in Portugal are long. 
  • Finally, while the entry of the first home-care team reduces the length of stay of bed-blockers, it does not fully eliminate bed-blocking.


These findings have important policy implications. If policy-makers aim at reducing bed-blocking, then home-care services are more effective than nursing homes. Indeed, the average bed-blocker does not have sufficiently high care needs to benefit from nursing home care. 

Additionally, home-care teams are more flexible than nursing homes as their capacity can be easily adjusted with respect to demand fluctuations. This is relevant for other countries where bed-blocking threatens the functioning of the health system, such as the UK, Canada or Australia.

According to this study, reducing bed-blocking does not generate meaningful savings to the health system. But there are likely positive effects on patient welfare, including health gains from reduced periods of bed-confinement, reduced likelihood of a nosocomial infection, or reduced waiting times for an elective admission. A serious effort to quantify these effects is needed. 



Contact details:

Ana Moura

Tilburg University

E-mail: a.c.moura@tilburguniversity.edu

Website: www.anamoura.site

Twitter handle: @ana_c_moura

Twitter address: https://twitter.com/ana_c_moura