Norway's aging population creating impossible demand for hospital
20 October 2009
Norwegian independent research agency SINTEF has estimated
If the country continues to use hospitals in the same way as now, the
health service in 2030 will need to employ every second young person in
the country and increase hospital bed capacity by 5000.
Recent estimates made by SINTEF hospital researchers indicate that
the 'flood' of elderly people, which will make itself seriously felt in
2016 – 2017, will have dramatic effects on Norway’s health service if
continue to be admitted to hospital as often and to stay there as long
as they do today.
Senior scientist Stein Ø Petersen of SINTEF Technology and Society
with his colleague, hospital planning
expert Asmund Myrbostad, say that it will be
impossible to increase hospital bed capacity by 5000 in 20 years,
because there is neither the time nor a sufficiently large work-force to
Measure could reduce the need
The researchers point out that a number of measures could be used to
reduce bed occupancy and the number of admissions, and that some of them
already form part of the government’s programme for coordinated health
“But even getting patients out of hospital more quickly than we do
today doesn’t mean that they will suddenly become healthy. Someone will
have to look after them when they have been discharged, and that will
require a work-force of quite other dimensions than we employ now”, says
More elderly people and fewer in work
SINTEF’s calculations are based on how general hospitals were used in 2008.
When the need for beds is estimated to be so high in 2030, this is
due to the fact that there will be far more elderly people than
today, and that the elderly are admitted more often, and remain in
hospital longer, than younger people. At the same time, there will be
fewer people in the active work-force to look after them and treat them
during the rest of this century.
According to the government’s white paper on health service
co-ordination, in 2000 Norway had 190,000 inhabitants aged 80 or more.
In 2030, the figure will be 320,000, and by 2050 it will have risen to
According to the white paper, the ratio of people of working age to
elderly people will be 3.5:1 in 2030 and 2.9:1 in 2050, compared to
4.7:1 in 2000.
Five thousand new hospital beds is equivalent to building six or
seven new large hospitals.
“For Norway to be able to develop its hospital capacity to such an
extent, planning would have to have started long ago. Nor has the
country a work-force that would be capable of staffing so many beds.
Between 40 and 50 percent of each leaving class of newly educated young
people would have to work in the health sector if hospitals were to have
5000 new beds in 2030, a proportion that is quite impossible”, say
Petersen and Myrbostad.
Hospital stays in focus
According to the researchers, recent surveys suggest that some
hospitals have vacant beds, while others would find it impossible to
increase occupancy rates.
The question of how many beds the hospital sector will need in the
future depends first and foremost on how long the average stay will be,
Today, the average stay is 4.7 days.
Petersen and Myrbostad say that lengths of stay vary widely from one
hospital to another, and that in general they are longer than in
Denmark, for example. They believe therefore that there is potential for
“But estimating by how much it would be realistic to reduce the
length of stay is a matter of pure speculation”, they say.
More elderly patients raise length of stay
Since 2000, the average length of stay has fallen by about one day.
During this period, the number of elderly persons in Norway has been
Stein Ø, Petersen says that the growth in the number of old people
itself increases the average length of stay. If each age group remains
in hospital in 2030 as they did in 2008, the “flood” of old people alone
would raise this figure by 0.2 days.
“And if we are to manage with the number of beds that we have today,
the average length of stay will have to fall by a day and a half”, he
Measures to reduce demand on beds
Myrbostad and Petersen have drawn up a list of measures that
could reduce the number of hospital admissions and lengths of stay:
- more elderly patients who are capable of being discharged from
hospital should be transferred to local authority nursing homes or
to home-based care services;
- primary health-care doctors will have to become better at not
prescribing unnecessary admissions;
- the amount of out-patient treatment by hospitals will need to be
- better hospital planning can reduce length of stay, eg by
reducing the time spent in bed before operations.
A need for manpower
“Nevertheless, some of these solutions will require more manpower in
the health sector, even if they do not make such great demands on care
provision as hospital wards”, emphasise Petersen and Myrbostad. The two
identify several measures that could help to meet the need for more
manpower: a move from part-time to full-time jobs; enabling staff to
retire later, and motivational campaigns to encourage young people to
work in the health services.
“It may also become necessary for patients’ families to help look
after elderly patients who are nearly well, and whom society
cannot take care of. We should not ignore the possibility that it will
not only be children’s illnesses that give us the right to sick-care
leave in the future”, says Petersen.
Risk of poorer services
The two hospital researchers also point to the danger that Norway will
have to put up with poorer hospital services in 20 years than those
“It is not impossible that the threshold for admission to hospital
will be higher than we have been used to. We also risk ending up with
health services that are determined by social class, in which patients
who are comfortably off purchase private hospital services that other
patients cannot afford”, says senior scientist Stein Ø. Petersen.