The COVID‑19 pandemic highlighted the need to have a sufficient number of hospital beds and flexibility in their use to address any unexpected surge in demand. Still, adequate staffing was more of a pressing constraint than bed numbers (OECD, 2023[1]).
Across EU countries, there were on average 4.7 hospital beds per 1 000 population in 2022 (Figure 7.21). Yet, the variation across countries is large. Bulgaria, Germany, Romania, Austria and Hungary had over 40% more beds per population than the EU average, while some of the Nordic countries (Sweden, Denmark, Finland) and the Netherlands had over 40% less beds than average.
Over the past decade, the number of hospital beds per capita has decreased in nearly all EU countries due partly to the growing use of day care and the reduction in average length of stays. On average, the number of hospital beds per capita fell by 10% between 2012 and 2022. The largest reduction occurred in Finland with a fall of over 50%. This was mainly due to a reduction in long-term care and psychiatric care beds, but the number of acute care beds also fell in Finland as a result of the centralisation of specialist care leading to mergers of hospitals and closures of some smaller hospitals (OECD/European Observatory on Health Systems and Policies, 2023[2]). The number of hospital beds per population also came down markedly in Lithuania, the Netherlands, Estonia and Luxembourg, despite most of these countries having already lower than the EU average number of beds per population. In Luxembourg, this reduction was driven mainly by strong population growth with the absolute number of beds remaining fairly stable. In contrast, the number of beds increased noticeably in Bulgaria and Romania.
Looking at hospital activities, there were 155 hospital discharges per 1 000 population on average across the EU countries in 2022. Hospital discharges were generally the highest in those countries that also had among the highest number of beds – Bulgaria, Germany and Austria (Figure 7.22). They were the lowest in the Netherlands, Italy and Portugal. These variations in hospital stays reflect to a large extent differences in the supply of beds, clinical practices, and payment systems that can provide incentives for hospitals to encourage bed usage.
Hospital discharges have fallen in recent years in most countries, falling on average across EU countries by 12% between 2019 and 2022. Discharges decreased in all EU countries during the pandemic in 2020 and 2021, as non-urgent services were disrupted to avoid people being infected and hospitals becoming overwhelmed. In 2022, Hungary, Lithuania and Romania still had discharge rates lower by around 25% than in 2019, while other countries such as Bulgaria, Portugal and Spain returned to discharge rates closer to their 2019 rates.
Bed occupancy rates provide an indication of any spare capacity in hospitals to admit additional patients if needed. Although there is no general consensus about the optimal occupancy rate, an occupancy rate of about 85% is often considered as a maximum to reduce the risk of bed shortages when there is a sudden increase in need for admissions as was the case during the pandemic (NICE, 2018[3]). Before the pandemic, bed occupancy rate in curative care units was fairly stable in EU countries, reaching 74% on average during the period 2012‑19. During the first year of the pandemic, the EU average bed occupancy rate decreased sharply to 63% in 2020, as non-urgent hospital care was suspended or slowed down during the early stages of the pandemic. The EU average rate recovered slightly in 2021 (65%) and in 2022 (66%), but remained well below the pre‑pandemic level. This was the case in all EU countries for which data are available (Figure 7.23). Ireland and Portugal had bed occupancy rates of 80% or higher in 2022, the highest among the EU countries. In contrast, Hungary, Cyprus, Bulgaria, Lithuania and the Slovak Republic had bed occupancy rates below 60% in 2022, indicating ample spare capacity.
