The disconnect between the data and the headlines

In this issue (page 397) Samuel Sheps and colleagues(1) use data to describe the consequences of bed closures and hospital downsizing. British Columbia closed 30% of its acute care beds over the 5-year period 1991-1996. "Doom and gloom" headlines in the Vancouver papers claimed that these cuts caused crises and disasters for British Columbians and their medical care system ("Expect more deaths as hospitals reorganized, nurses' union says";(2) " 'Prescription for disaster' -- union and hospital staff decry ministry's closure of Shaughnessy";(3) "It's tougher to get into hospital"(4)). One would expect, however, that if more people had bad experiences after bed closures than before, these results should be showing up in the "data." If the nurses' union is right, we should find a higher death rate after bed closures, particularly among vulnerable groups such as elderly people. If indeed it is "tougher to get into hospital," we should find fewer people getting in. Is this what the data tell us? Sheps and colleagues have, in effect, added up all the anecdotes and all the bad and good experiences before and after bed closures, and what do they find? Does this mean patients were discharged quicker and sicker, another frequent allegation of those claiming crisis and imminent system collapse? Data from Winnipeg, where 21% of hospital beds were closed between 1992 and 1995, provide more facts about bed closures. The Winnipeg findings about bed closures(5) parallel those of Sheps and colleagues. The closures had little effect on access to hospital care: stays were shortened, and many inpatient procedures moved to the outpatient setting. Death rates were unchanged. There was also no evidence that patients were discharged quicker and sicker: there was no increase in readmissions, and no increase in emergency department or physician office visits in the 30 days after hospital discharge. Despite bed closures, there were dramatic increases in the numbers of high-profile surgical procedures, such as angioplasty and bypass and cataract surgery.