Who's that sleeping in my bed? Potential and actual utilization of public and private in-patient beds in Irish acute public hospitals.
OBJECTIVE
To examine the impact of the unusual public/private mix on public and private in-patient bed utilization within Irish acute public hospitals.


METHODS
Data from the Department of Health and Children and the Hospital In-Patient Enquiry were used to estimate and compare potential and actual utilization of public and private designated in-patient beds in 54 acute public hospitals from 2000 to 2004.


RESULTS
Private in-patients used more bed days than were potentially available to them in 14.1% of hospital-year observations. The equivalent figure for public in-patients was 12.6%. Although the prevalence of excess utilization of private beds was relatively small, it did increase over the study period. Hospitals with excess private utilization were characterized by a relatively low proportion of private- or non-designated beds despite their patient profile being broadly similar to that of hospitals where there was no excess private utilization.


CONCLUSIONS
Despite policies designed to limit private practice in Irish acute public hospitals, some hospitals have apparently been able to overcome these restrictions. In a system where financial incentives to treat private patients exist both for consultants and hospitals, it is not clear whether this excess private practice in public hospitals reflects a more efficient utilization of resources (when demand from public patients is low) or the displacement of public patients in favour of private patients. However, that a smaller number on hospital waiting lists possess private health insurance provides some support for the displacement hypothesis. Thus, it appears that policy-makers may need to reconsider attempts to ensure an appropriate division of acute public hospital resources between public and private patients.
O'Reilly
Jacqueline
J
Health Research and Information Division, Economic and Social Research Institute, Dublin, Ireland. jacqueline.oreilly@esri.ie
Wiley
Miriam
M
D001509:Bed Occupancy / Q000706:statistics & numerical data*; D006291:Health Policy; D006779:Hospitals, Public; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D055818:Public-Private Sector Partnerships