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Dave Chase, CEO of Avado, made this claim in a TechCrunch article:

Prevention-focused countries such as Denmark have dramatically lowered the need for hospitals. Once at 155 hospitals, they are at less than a third of that today. I find this easily-known fact is news to healthcare providers I speak with.

I find it quite astonishing, but unfortunately he provides no evidence for the claim in the article.

Has Denmark reduced the number of its hospitals from 155 to less than 51?

If so, has the demand reduced by a similar amount? (I'm just trying to figure out if there are any catches, like each remaining hospital has grown by a factor of three, waiting lists have blown out, the definition of hospital has changed, etc.)

(I'm not asking for proof of the cause of the reduction; even if it turns out the reduction is caused by measures such as banning Facebook on hospital firewalls, I would still be impressed with that health result.)

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    Consolidation of small hospitals into big hospitals has surely happened over the last decades. The interesting question is whether the number of hospital beds went up or down. – Christian Jul 31 '11 at 16:06
  • @chr I was going to say the same thing. – Sklivvz Jul 31 '11 at 16:09
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    @Christian, yeah, I suggested that may have been what happened - that's why I asked about "demand". Hospital beds is somewhat of a proxy for that. That said if, for example, surgeries are less intrusive these days, and patients get out faster, that means less beds are required to meet the same demand. – Oddthinking Jul 31 '11 at 16:38
  • Determining the demand for hospital beds is tricky. Hospital beds demand patients. They are not like hotel beds where you sometimes have a hotel that is half empty. – Christian Jul 31 '11 at 21:45
  • @OT: in a socialised healthcare system demand doesn't dictate availability. Beds get added or scrapped based on some bureaucrat's decision. If there's fewer beds than demands, waiting lists grow longer. That's what's happening all over Europe. One effect is that people die waiting, causing the number of procedures to drop. Another is that people simply don't even try to get medical care (or pay private for it in another country, Spain is popular for many Europeans because of its high standard medical facilities and relativly low cost), causing the number of procedures to drop. – jwenting Aug 1 '11 at 6:12
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I thought I might get someone questioning this data so I asked the source (an American MD who leads one of the major tech/software projects over there but is US-based) who is very knowledgeable of the Denmark success story. Here was his verbatim response... "the average number of days went down, the number of beds went down in percent even more than hospital . This is happening today in Geisinger and Kaiser as well with PCMH [my note: PCMH = patient centered medical home] level care better upstream care, care coordination of chronic disease, lower downstream need for beds. In addition this is impacted by ambulatory surgery and a program like that tried by Advocate in Chicago of hospital at home with remote monitoring and video conference-ing. this is our future for sure much safer, less wasteful but the key is the hospital bed is seen as a failure and is a cost center not a profit center.

in the USA the average length of stay is 6.7 days -- Denmark 3.9. Cost per hospital stay in Denmark $6,700 in the USA $19,456. We have to use dialyze twice as often. but with higher mortality rates and lower life expectance for the disease that require dialyze for example.

[Ref: Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study, Denis Protti and Ib Johansen, Issues in International Health Policy, March 2010]

There's an interesting parallel with Deming's work with the auto industry. An American idea gets ignored by Americans so it's taken abroad and implemented with gusto. In Deming's case, Toyota et al embraced it and then it took Detroit 30+ years to catch up. Likewise, the PCMH concept originated in the US in 1967 and Denmark adopted it. 40+ years later, Denmark is spending far less and getting far more and we (Americans) are playing catchup.

As Ben Franklin said, "an ounce of prevention is worth a pound of cure." It certainly applies to medicine. In the US, it's a shame to say that it's more lucrative for a MD to amputate a diabetics leg than it is to care for him in his chronic condition and avoid that from ever needing to happen.

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    You need to cite your sources for this answer. Who is the doctor? Why should his opinion carry so much weight? As it stands this is an appeal to authority. I'd also suggest linking to where we can see the PDF you reference somewhere online. – John Lyon Aug 1 '11 at 3:38
  • Note: I've inferred the reference from the filename provided by Dave Chase, and edited it in. – Oddthinking Aug 1 '11 at 6:49
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    Thanks, Dave, for coming to Skeptics.SE to respond to the claim. It's great to hear from the original proponent. I've read what your (anonymous) doctor friend has written, and also the report on the IT situation in doctor's offices. Neither seems to touch on the claim that Denmark has reduced its hospitals from 155 to less than 1/3 of that. – Oddthinking Aug 1 '11 at 6:59
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    Can't find a reference to "PCMH" in the linked article. Isn't a PCMH just a hospital in disguise? And if it focuses on the less severe/further recovered patients, its costs per patient will be lower. Such differences make international comparisons harder. – MSalters Aug 1 '11 at 11:27
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Once at 155 hospitals, they are at less than a third of that today.

A third of 155 is 51.67 - hence the statement implies that there are 51 or fewer hospitals.

Wikipedia provides a list of hospitals in Denmark. By my count, there are 89 in the list.

89 is more than 51. 89 is 57% of 155. If there really were 155 hospitals at some point (which I haven't confirmed) a more accurate statement would be "they have reduced that by more than a third today."

Potential sources of error in this analysis include:

  • I relied somewhat on Wikipedia. I followed up a couple of its sources (e.g.), and did some spot-checks to confirm the hospitals still existed, and found no errors. I may easily have missed some that, for example, have since closed down. Update: Thanks to the help of @Darwy (see comments), it seems the Wikipedia site over-estimates the number of hospitals by around 6. This weakens this argument significantly, but doesn't invalidate it.
  • I relied on translation tools and some very rusty Swedish language skills to read the Danish hospital documents and web-sites. I may have misunderstood some details.
  • It isn't clear that the original definition of hospital that got a count of 155 is the same definition used by the Wikipedia authors. It could be that the initial definition was stricter (e.g. not including psychiatric hospitals), and would exclude some of those 89.
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    I know that Wiki link isn't exactly up to date for private hospitals, there's one that's 1.5 km up the road from where I live, yet not listed on the site. It's a small private hospital, so they might have excluded the ones with less than "X" number of beds, etc. – Darwy Aug 1 '11 at 10:57
  • @Darwy! You speak Danish? Yay! Could you spot-check a few more of the Wikipedia hospitals to confirm they really exist, pretty please? If some are missing from the Wikipedia list, that doesn't hurt my argument, but if a significant number of those present have since closed, it invalidates it. – Oddthinking Aug 1 '11 at 11:44
  • There's currently a HUGE restructuring of the hospitals and service areas in Denmark. For example, the hospital where I had my son no longer has a maternity wing; it's been moved 15 km to a different hospital, etc. – Darwy Aug 1 '11 at 13:14
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    Comparing just the Region Sjælland Wiki: Fakse, Korsør, Nakskov, Nykøbing Sjælland has been closed. Holbæk, Kalundborg, Køge, Nykøbing Falster, Næstved, Ringsted, Roskilde og Slagelse are still open. Source: regionsjaelland.dk/regionens-opgaver/sygehuse/findsygehus/Sider/… – Darwy Aug 1 '11 at 13:21
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    @Oddthinking The number "155" appears in US War Department Technical Bulletin 52, Medical and Sanitary Data on Denmark. There were 155 hospitals with a total of 24,056 beds, as of 31 December 1939. books.google.com/… – DavePhD Feb 17 '16 at 14:47

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