Why have thousands of hospital beds closed in France?

More than 43,000 hospital beds for inpatient care have closed across France in the past 10 years, a new report has said, with staff shortages and changes in care plans the main reasons cited.

The number of beds available for full hospitalisation has dropped by 43,500 since the end of 2013 (a 10.5% drop over 10 years), and fell by 1.3% in 2023 alone, after a drop of 1.8% in 2022, says a new report by national statistics and research body DREES (Direction de la recherche, des études, de l'évaluation et des statistiques).

The report shows that as of December 31, 2023, there were 369,423 beds available for full hospitalisation care across France’s 2,962 hospital establishments (whether public, private, or non-profit).

Read also: Why has France lost 80,000 hospital beds in 20 years? 

Changes in care plans

A major reason for the drop in full hospitalisation beds is the so-called virage ambulatoire (‘ambulatory shift’) policy, which was introduced in the early 2010s. This was a policy that aimed to reduce full hospitalisation for patients where necessary or possible, partly to reduce social security costs but also due to advances in surgery and anaesthesia.

However staffing problems have also contributed over the past few years. The Fédération hospitalière de France states that in 2022, 99% of public sector establishments were facing staff shortage problems, and the same year, 6.6% of empty nursing posts remained unfilled.

Read also: Hospital beds ‘closed’ in France due to lack of workers 

Partial hospitalisations on the rise

Full hospitalisation bed numbers may have been falling, but the number of partial hospitalisation places (usually meaning hospitalisation without overnight stays) has been rising steadily since 2013, the report shows.

A total of 20,900 places have been created in 10 years, an increase of 31%. These places have also increased since the Covid crisis. In 2023, 4.1% more partial places were created, up from 3.1% in 2022, and 3.4% in 2021.

The report said that there were 88,504 partial hospitalisation places nationwide. And, unlike overnight stay beds, these beds may be used by several patients a day as they are admitted, treated, and then discharged.

At-home care

Another alternative increasingly being offered is l'hospitalisation à domicile (HAD, home hospital treatment), which enables some care - such as some forms of chemotherapy, palliative care and rehabilitation treatments - to be carried out at the patient's home. This aims to reduce overcrowding in hospitals, while also allowing patients to remain in the comfort of a familiar environment during treatment.

HAD increased rapidly in the Covid era (up 12.9% in 2020) as a way to reduce overcrowding and increase patient safety. HAD care increased by 4.1% in 2023 and by the end of the year there was capacity for 24,100 patients to be treated simultaneously under the HAD scheme, up from 18,900 before Covid.

Hospitalisation at home now represents 7.7% of the total capacity for treatment that would otherwise be a short or medium in-patient stay (excluding psychiatry).

Despite these changes there is still a major shortfall in the availability of hospital beds. Even with the 20,900 partial hospital places created, and around 12,100 more HAD places created over 10 years, France has 10,500 fewer hospital places in total compared to 2013. 

The number of places available in critical care is now 0.9% below pre-Covid levels, with 310 fewer intensive care beds, and 200 fewer in-patient care beds than in 2019.