Doug Johns, AIA Project Architect Don Zirkle, Assoc. AIA Director, Healthcare Facilities Research Earl Swensson Associates Nashville, Tennessee

The traditional hospital, with its focus on inpatient care, is undergoing a major transition. The clear trend now is outpatient treatment. As a result, the very nature of the traditional hospital is radically changing. Because of the transformations occurring within healthcare , there has been a drastic reduction in the number of licensed hospital beds nationwide. As reimbursement for inpatient beds has fallen, it is almost certain that this decline will continue. From 1992 to 1995, for instance, the number of licensed beds in the United States decreased from 923,000 to 700,000. By the year 2000, it is estimated that this number will fall to 500,000.1 Looking even farther, it is predicted that there will be fewer than 300,000 hospital beds by the year 2040.2 This portends a major change. Needless to say, hospitals are already looking to compensate for the declining revenue the loss of these beds represents.

Although we aren't likely to see the total demise of the inpatient hospital, the nature of the institution will certainly have to change to survive. For the foreseeable future, certain procedures --heart and brain surgery and organ transplants--will be performed in inpatient hospitals. Some demand for beds will be created by emergency room admissions. With the demographic shift toward a more elderly population, chronic care patients will place an increased demand on the system. But the number of traditional medical/surgical beds needed for patient care is decreasing as more and more procedures are being performed on an outpatient basis. By the year 2000, 80 percent of care provided in hospitals will be for outpatients. Only the critically ill will require inpatient medical procedures.

Two probable scenarios have been posed for the future of the inpatient hospital--either there will be "mega-hospitals," large, urban facilities designed specifically to treat a wide range of diseases, or there will be smaller specialty hospitals with fewer beds, dedicated to the treatment of specific diseases. As is often the case in healthcare today, the answer will probably lie in the reimbursement system. The type of facility which can provide the most economical medical treatment is most likely to be the hospital of the future.

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