Overcrowding and "floor" patients in state hospitals: institutions can make a difference.

Two recent articles and one official document have drawn attention to the problem and impl icat ions of overcrowding in state hospitals , especial ly the issues related to floor patients (1,2,3). The proposals to counter overcrowding include those based on the reasons for overcrowding at tertiary care level , bypassing of other levels of care, lack of an effective referral system, and the increasing demand for specialist care (3). The long term strategies aimed at the level of the health system appear to have had little impact on the situation. If at all, in the recent past (1994 to 1998), the occupancy rates have increased in tertiary care hospitals, in contrast to other l e v e l s o f care (Table 1) . T h e reason may be s l o w implementation of these strategies, because that requires heavy investment of resources (eg. improving services in other levels of care), and the controversial nature of some (eg. delinking primary care from tertiary care hospitals).