The COVID‑19 pandemic highlighted the need to have sufficient hospital beds and flexibility in their use, to address any unexpected surge in demand for intensive care. Still, adequate staffing was more of a pressing constraint than bed numbers (OECD, 2023[1]). Further, a surplus of hospital beds may lead to overuse and therefore costs, as many patients can be treated effectively on a same‑day basis in hospitals or primary healthcare facilities. Therefore, a balance needs to be found between ensuring sufficient bed capacity and value‑for-money considerations.
Across OECD countries, there were on average 4.2 hospital beds per 1 000 population in 2023 (Figure 5.19). Rates were much higher in Korea (12.6 beds per 1 000) and Japan (12.5 per 1 000). Over two‑thirds of OECD countries reported between 3 and 8 hospital beds per 1 000 population, with the lowest rates in Mexico, Costa Rica and Sweden.
Since 2013, the number of beds per capita has decreased in nearly all OECD countries, due in part to greater use of day care and reductions in the average length of stay. The largest decrease occurred in Finland, with a fall of over 50%, mainly affecting long-term care and psychiatric care beds. Reduced capacity of 1 bed or more per 1 000 population was observed in Austria, Lithuania, Luxembourg and the Netherlands, also due in part to long-term care and psychiatric care beds. In contrast, the number of beds increased strongly in Korea, with a significant number of these dedicated to long-term care.
Hospital bed occupancy rates offer complementary information to assess hospital capacity. High occupancy rates of curative (acute) care beds can be symptomatic of a health system under pressure. Some spare bed capacity is necessary to absorb unexpected surges in patients requiring hospitalisation. Although there is no consensus about the “optimal” occupancy rate, a rate of about 85% is often considered a maximum to reduce the risk of bed shortages (NICE, 2018[2]). In 2023, the average bed occupancy rate was 72%, but the rate was higher than 85% in 2 of the 29 OECD countries with comparable data: Ireland and Canada (Figure 5.20). Occupancy rates were comparatively low in Türkiye, Hungary and many central and eastern European countries. Compared to 2013, occupancy rates were lower in almost all OECD countries in 2023.
While general hospital bed capacity matters, intensive care unit (ICU) capacity is an essential resource in many health emergencies or other major crises, delivering care for critically ill patients, as demonstrated during the COVID‑19 pandemic. Notwithstanding definitional differences, on average across 31 OECD countries there were 17 ICU beds per 100 000 population in 2023 (Figure 5.21). Numbers varied markedly from around 40 beds or more per 100 000 population in Czechia and Estonia to below 5 beds per 100 000 in New Zealand and Sweden. Compared to the pre‑pandemic situation, most countries have increased ICU capacity.
