The dramatic differences in levels of acute care hospital resources that were documented in the national editions of the Dartmouth Atlas of Health Care persisted throughout the 1990s, although the medical industry has undergone a period of profound change.

This chapter addresses resource allocation in 1996, the most recent year for which data are available. Since that year, there has been significant consolidation of the hospital market in Michigan. These changes will undoubtedly be reflected in future analyses of the state’s health care resources.

The numbers of acute care hospital beds, hospital employees, and registered nurses employed by acute care hospitals varied substantially among Michigan’s hospital service areas. Generally the supply of hospital resources was higher in urban areas, where the population is declining but hospital beds are not being closed at a comparable rate, and in very rural areas, where the minimum number of beds necessary to operate an acute care facility can result in very high per capita supplies of beds. The numbers reported in this chapter include all Michigan hospital service areas, including those with very few residents who were members of Blue Cross Blue Shield of Michigan. In Chapter Three, only those hospital service areas with at least 10,000 BCBSM members are included in the analysis, in order to avoid the statistical instability inherent in using very small numbers.

Data from the American Hospital Association and the Medicare program were used to estimate the number of staffed acute care hospital beds, full time equivalent hospital employees, and registered nurses employed in acute care hospitals allocated to the population of each hospital service area.

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NOTICE TO ATLAS READERS
While not giving answers, the atlas raises questions about health care service use that merit careful consideration. "High" rates of use are not necessarily bad and "low" volumes good (or vice versa). Our goal is to move toward rates that are consistent with high quality health care, which need to be determined with local clinical, community and patient discussion and dialogue.

The atlas is not a physician or hospital report card. When reviewing data, note that the Hospital Service Areas in the atlas were defined by the atlas author. They may differ significantly from what a hospital considers its market area.