Social, economic, educational and cultural characteristics of the people and the attitudes of the medical profession influence both the manner in which existing hospital facilities are utilised and the extent of utilisation.
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However, where hospital facilities fall woefully short of the bare minimum requirement, utilisation statistics do not depict the correct picture.
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There is no such thing as a standard population to be served by a hospital although a district general hospital usually serves 150,000 to 350,000 people.
The exact size of a hospital’s catchment area and of the population served depends on a variety of factors.
The following factors affect the manner and extent of hospital bed utilisation, a knowledge of which will be of help during the planning process.
1. Hospital bed availability:
As opposed to developed countries where utilisation is high because of large availability of hospital beds, in developing countries it is because of low bed: population ratio. A high available bed complement may lead to low bed occupancy rate.
2. Population coverage and bed distribution:
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Since full coverage of population depends upon equitable regional distribution rather than on total number of beds, an even distribution increases hospital utilisation by wider coverage of population.
People from scarcely populated areas generally find it necessary to travel to district hospitals or metropolitan towns for more sophisticated type of medical care.
3. Age profile of population:
A population with high life expectancy (and consequently a higher proportion of aged persons) tends to raise the volume of hospitalization. The effect of age on utilisation indices is reflected in an increase in the per person hospitalization rate and in average length of stay.
4. Availability of medical services other than hospitals:
Availability of well-organised dispensaries, outpatient clinics, mobile clinics and competent general practitioners reduce the load on hospital beds in an area.
5. Customs and attitudes of medical profession:
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Doctors order admissions primarily for medical reasons. On the other hand, people themselves influence the decision for admissions if a strong “hospital habit” is developed in them, or against admission because of fear of the hospital and unwillingness for separation from family.
Physicians’ attitude on these matters and their philosophy on early ambulation and home care influence hospital bed utilisation.
6. Method of payment for hospital services:
Hospital services can be free, on payment by patient directly to the hospital, or by indirect payment through sickness insurance. Hospital utilisation is greatly influenced in the last case.
7. Availability of qualified medical manpower:
In areas with very small number of qualified doctors, much illness remains undetected, and therefore admission rates are low.
However, the customs and attitudes of medical profession and pattern of services available influence hospital utilisation more than the number of doctors
8. Housing:
Breakup of the joint family system and a trend for nuclear families living in independent apartments result in increasing hospital admission because of inconveniences encountered in caring for the sick person at home.
Shortage of home help in nuclear families and shortage of space in modern apartment dwellings are jointly responsible for demand for hospital admissions in urban areas.
9. Morbidity pattern:
Acute communicable diseases result in a demand for short stay hospitals; whileas chronic infective and degenerative diseases create demand for Long-stay institutions.
The former raises the admission rate and bed turnover, the latter needs longer average length of stay.
10. Hospital bottlenecks:
The efficiency with which supportive services (radiography and laboratory, etc.) support and reinforce the total hospital organisation has direct influence on hospital utilisation.
Poor supportive services and cumbersome admission and discharge procedures act as “bottlenecks” and result in longer hospital stay.
11. Internal organisation:
A high degree of specialisation where specialist departments function as watertight compartments result in segmentation within a hospital, resulting in lesser degree of utilisation due to tight compartmentalization of beds these points out the need to provide the greatest flexibility in bed planning
12. Public attitudes:
There are certain factors which are of considerable importance in determining where people will go to receive medical care, these are public attitudes.
The category includes social and religious attitudes, local customs and traditions, beliefs and mores, and group preferences.