Frustrated in its attempt to curb hospital spending by congressional act, the Carter administration plans new moves to curb hospital construction.
A White House memorandum approved by President Carter calls empty hospital beds throughout the country "a major contributor" to inflated health spending and one whose control could, in time, help ease the patient's bill.
Hospitals include the costs of financing new building, expansion and equipment as part of their charges, though they seldom are identified on a patient's bill.
Hospital capital expenditures approved by state health planning agencies totaled $4.8 billion in 1979, Nathan Stark, undersecretary of health and human services, told a health planners's meeting yesterday.
Federal, state and local health planning guidelines helped reduce that amount from the 1978 total of $5.5 billion, Stark said. Yet, he added, the 1979 figure is "substantially above the $3 billion limit" the administration sought with cost-control legislation that has foundered in Congress since 1977.
A White House official said yesterday that the administration plans to use a mix of new regulations, executive orders and legislation to attack what it views as excess hospital construction.
"There are a lot of agencies involved, and all the details aren't complete yet," he said. Among them, he reported, will be trimming the billions of dollars in federal Medicare and Medicaid payments to eliminate any reimbursement for unneeded "capital costs." This could include interest and principal on hospitals' building debts, and their set-asides for depreciation in parts of the country where no new building is needed.
Also among measures will be some to limit federal grants, loans and loan guarantees for new building or expansion, and actions to discourage state and local tax-exempt bond issues to finance unneeded building.
The administration also will try to limit construction of new federal facilities, mainly veterans hospitals.
This may be one of the most controversial proposals. But all of the moves may be fought by one interest or another, including veterans groups, hospitals and their associations, doctors, local governments, the banking, lending and bond industries and others.
"There may be opposition," the White House official said. "But we think there will also be substantial support. A lot of people -- business, labor, health insurance companies, all the people worried about health costs -- are wondering why we don't have better mechanisms to control costs."
He said the administration does not see the new actions as a substitute for hospital cost-control legislation. Controls on hospital capital could take years to have a significant effect, he said.
Other officials have said that congressional inaction on cost-control forces them to look at many new ways of regulating costs.
Stark told the American Health Planning Association in San Francisco that "the department has under consideration several proposals which would make substantial changes in the Medicare-Medicaid system."