The Impact of Halting Elective Admissions in Anticipation of a Demand Surge Due to the Coronavirus Pandemic (COVID-19)

Med Care. 2021 Mar 1;59(3):213-219. doi: 10.1097/MLR.0000000000001496.


Background: In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions.

Objectives: To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, and to explore the scenario when demand remains below capacity.

Research design: An economic simulation to estimate the net financial impact of halting elective admissions, combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. Deterministic sensitivity analyses explored the results while varying assumptions for demand and capacity.

Subjects: Inputs regarding disease prevalence and inpatient utilization were representative of the US population. Our base case relied on a hospital admission rate reported by the Center for Disease Control and Prevention of 137.6 per 100,000, with the highest rates in people aged 65 years and older (378.8 per 100,000) and 50-64 years (207.4 per 100,000). On average, elective admissions accounted for 20% of total hospital admissions, and the average rate of unoccupied beds across hospitals was 30%.

Measures: Net financial impact of halting elective admissions.

Results: On average, hospitals COVID-19 demand for hospital bed-days fell well short of hospital capacity, resulting in a substantial financial loss. The net financial impact of a 90-day COVID surge on a hospital was only favorable under a narrow circumstance when capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions.

Conclusions: Hospitals that restricted elective care took on a substantial financial risk, potentially threatening viability. A sustainable public policy should therefore consider support to hospitals that responsibly served their communities through the crisis.

MeSH terms

  • Adult
  • Aged
  • Bed Occupancy / economics
  • Bed Occupancy / statistics & numerical data
  • COVID-19 / epidemiology*
  • Economics, Hospital / statistics & numerical data*
  • Elective Surgical Procedures / economics*
  • Female
  • Hospital Bed Capacity / statistics & numerical data
  • Humans
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Male
  • Middle Aged
  • Monte Carlo Method
  • Pandemics
  • SARS-CoV-2
  • United States / epidemiology