Ezekiel Emanuel, MD, an architect of the Affordable Care Act, writes in “Reinventing American Health Care”:
“One major consequence of the rise of digital medicine will be that about 1,000 of the approximately 5,000 acute-care hospitals in the United States will close by 2020. This may be a conservative estimate; some consultants predict that a many as 2,000 hospitals will close… On average, patients occupy fewer that 67% of all hospital beds, and the more than 3,000 hospitals with 2000 or fewer patient beds are operating with 40% of their beds empty…
Many local populations will fight against these closures. In many communities the hospital is the biggest employer with well-paying jobs and the local luminaries sit on their boards. But fighting the closures is the wrong thing to do. Closing hospitals does not spell doom and gloom. After all, how many of us want to stay a long time in the hospital? Hospital stays are not restful, recuperative vacations; they have become almost as bad as stranded cruise ships, with constant interruptions, disrupted sleep and risks of infection and other untoward events. Society is better off with fewer people in hospital beds.
The hospitals that close may be converted to outpatient service centers. They may serve as places for physician offices or surgical centers. More importantly, the health care personnel will continue to be employed. The shift in care out of the hospital will mean that nurses, health aides, respiratory therapists, physical therapists, and others who once walked the wards will be employed visiting patients in their homes and at senior centers, delivering care in other setting besides the hospital. Further, the hospitals that remain open will operate much more efficiently and will be focused on only the most severely ill patients, those requiring transplants, implantations of devices, or intensive care. Indeed hospitals of the future are likely to be intensive-care units only.
