Is your hospital really necessary?

Do you own a car?

If so, why? Habit, old-fashioned convenience, or the comfort of having wheels on standby? And what would make you give it up? Maybe a new start, concerns about climate change – or the city finally opening a tram-service that works.

These days, more people – especially city dwellers – are parking ownership for good. Why pay for insurance, repairs, the odd jelly baby wedged under the seat, when you can tap Uber, Bolt or Careem and be on your way, sharing a ride rather than bankrolling a depreciating asset?

For years, having a car was non-negotiable. Now, for many, it’s an overhead not worth keeping1,2.

On a recent walk to the supermarket, it struck me how easily we adapt: the shops are close, I don’t need a car. But even if I did, a ride-hailing app solves the problem with one thumb, zero fuss – no engine light, no annual MOT, just movement paid ‘as you go’. This is the modern way: only pay for what you need, when you need it.

So what on earth does this have to do with healthcare? Far more than you might first think. It’s all about overheads and who carries them.

Hospitals have long been the private car of healthcare: reassuring, reliable, always there – even if most of the time, you’re not using most of what they offer. Wards must be staffed and lit; equipment, even if idle, must be bought, serviced, upgraded and insured. The price of keeping a hospital ‘just in case’ is just as steep as that driveway ornament that rarely leaves the curb.

But things are changing – and fast.

Hospital-at-home – virtual wards, mobile clinics, whatever you call them – are the ride-hailing model come to medicine. It’s no longer about the monolith, the big building, but about sharing the resource, stretching it further using logistics, software and mobile expertise2,1.

Recent UK data show that hospital-at-home models consistently reduce costs, sometimes by as much as 80%, and cut hospital bed use by several days per patient on average. A recent evaluation in London found remote ‘hospital’ care saved over £1.3 million in a year, with 95% of patients preferring the home model2,3. Systematic reviews in the BMJ confirm outcomes are as good as, or better than, inpatient care, with fewer complications and readmissions4. Even in the US, where private hospitals are as central to society as the family sedan, analyses suggest costs drop by up to a third when care moves home5.

Why such dramatic savings? Overheads. Instead of paying for the financial equivalent of baubles in the glove compartment – empty beds, half-used wards, heating and maintenance and the rest – systems pay only for what’s needed, when it’s needed: a pulse oximeter here, a staff visit there, all scheduling handled just-in-time. For most stable patients, the new hospital is their house – and the results speak for themselves2,4.

Some will say, “But we still need hospitals”. Absolutely – emergencies, diagnostics, ICUs, major trauma. But for the daily routine, the ‘ward round’, and the careful watching and waiting that makes up most in-patient care, the logic is shifting. The rise of virtual wards is the Amazonification of healthcare: logistics-first, resource-shared, precision where it matters, nothing wasted.

And as with car ownership, the social logic is evolving too. Not everyone can go without a car, just as not every patient is suited for hospital-at-home. But for the majority, the combination of on-demand expertise, data-driven allocation and the comforts of home make it a better, saner fit for the 21st century – and for increasingly strained health budgets.

So perhaps the real question hospitals face isn’t ‘How do we carry the overhead?’ but ‘What’s the future of ownership in healthcare?’. Because the days when a big building (or a big car) was a mark of progress are waning fast. What matters is outcomes – what gets done, not what sits waiting to be used.

Are hospitals the next private car: still there, but not the default? If the trends are anything to go by, healthcare is finally learning to share the ride1,2,4.

Sources

1. What is the future of British hospitals? https://www.economist.com/britain/2025/03/27/what-is-the-future-of-british-hospitals

2. Cost drivers and feasibility of a hospital-at-home programme for geriatric care in northeastern Mexico: a retrospective observational study

https://pmc.ncbi.nlm.nih.gov/articles/PMC11966944

3. Hospital at Home evaluation reveals huge cost savings, better outcomes and sky-high patient satisfaction

https://clch.nhs.uk/about-us/news/hospital-home-evaluation-reveals-huge-cost-savings-better-outcomes-and-sky-high-patient-satisfaction

4. Comparison of Hospital-at-Home models: a systematic review of reviews https://bmjopen.bmj.com/content/11/1/e043285

5. Cost effectiveness of home care versus hospital care https://pmc.ncbi.nlm.nih.gov/articles/PMC9893595/