Study details and key findings

For the study, researchers used CDC's COVID-19 data tracking dashboards to collect hospital occupancy metrics for almost every U.S. hospital between Aug. 2, 2020, and April 27, 2024. Then, the researchers combined this data with national hospital rates and official population projections from the U.S. Census Bureau to estimate future hospital occupancy scenarios through 2035.

Hospital occupancy is determined by the hospital census divided by number of staffed hospital beds. 

According to the researchers, the average national hospital occupancy was approximately 64% in the decade before the pandemic. Since then, the average national hospital occupancy has increased to 75% — an increase of 11 percentage points.

"We've all heard about increased hospital occupancy during the height of the COVID-19 pandemic, but these findings show that hospitals are as full, if not more so, than they were during the pandemic, even well into 2024 during what would be considered a post-pandemic steady state," said Richard Leuchter, an assistant professor of medicine at the University of California, Los Angeles' (UCLA) David Geffen School of Medicine and the study's lead investigator.

After modeling future hospital capacity, the researchers found that if the hospitalization rate and staffed hospital bed supply do not change, average hospital occupancy could reach 85% by 2032, leading to a bed shortage.

"For general hospital beds that are not ICU-level, many consider a bed shortage to occur at an 85% national hospital occupancy, marked by unacceptably long waiting times in emergency departments, medication errors and other in-hospital adverse events," Leuchter said. "If the U.S. were to sustain a national hospital occupancy of 85% or greater, it is likely that we would see tens to hundreds of thousands of excess American deaths each year."

Researchers' commentary

The researchers made several recommendations for addressing the potential hospital bed shortage in the United States.

For example, the researchers said that hospital bankruptcies and closures need to be prevented. They said some ways to do this include changing hospital reimbursement schemes and introducing new regulations on private equity healthcare.

The researchers also said that ongoing staffing shortages need to be addressed, including issues like burnout and obstacles to recruitment. One major obstacle for recruitment has been the U.S. State Department's 2024 decision to freeze all new visas for international nurses, something Leuchter said could be "potentially catastrophic."

Leuchter also called for "more innovative care delivery models that can reduce hospitalizations by diverting would-be admissions to specially designed acute care clinics."

How to get ready for the coming bed shortage 

By Vidal Seegobin, Vice President, Advisory Board, Jennifer Puzziferro, Senior Director, Optum Advisory, Ted Karniewicz, Senior Director, Optum Advisory, and Tiffany Steffen, Vice President, Optum Advisory

Advisory Board has been tracking the capacity crunch at hospitals and health systems for a while now, and these findings should be a warning sign for healthcare leaders. Although it's easy to feel discouraged by significant and persistent headwinds, there are still strategies that can help leaders ensure enterprise success.

1. Consider capacity management and growth together.

To start, leaders must accept that capacity management and growth are now interrelated concepts, even though they're separated by time horizons. It's important to have your planning, ops, and finance teams all in the same scenario planning sessions (if they're not already).

2. Find ways to improve the patient journey.

The patient journey is also an important area for health systems. Advisory Board's ambulatory research has shown that the common patient experience is not a track, but a plinko board. This means that there are clear opportunities for developing a path of least resistance for different patient populations.

To improve efficiencies in patient throughput, leaders should focus on developing high performance hospital case management and transitions of care programs, which will help create capacity for new patient revenue.

Proactive discharge planning, focused care transitions (including handoff to providers at the next site of care), and relationships with post-acute care facilities will drive reductions in length of stay, create better systems of care for patients, improve communication, and contribute to an organization's quality and financial goals.

3. Improve clinical effectiveness and efficiency.

Focusing on clinical effectiveness and efficiency can also help hospital systems tackle capacity challenges. Clinical variation reduction initiatives that establish and implement care standards for targeted conditions improve quality, patient and provider experience, and lead to reduced cost per patient day.

4. Turn to international peers for guidance.

Hospital leaders in the United States could also look toward their international peers for guidance on this issue. Based on the study's modeling, the projected bed shortage in the United States looks a lot more like the hospital sector overseas.

International health systems have employed more aggressive care standardization work, increased coordination with partners across the care journey, and better management of complex patients to combat capacity issues.

For more insights on the future of hospital services, check out our new brief "17 things CEOs need to know in 2025", which can help leaders craft an effective strategy that aligns with their local demand trajectory, competition, and capabilities.