A hospital bed in Wisconsin comes with 2.8 times the building of one in Nevada. Patient rooms are 3% of the difference

Add up every general hospital's floor space in a state and divide by its beds. Across the country the answer is 2,808 square feet per bed. In Nevada it is 1,554; in Wisconsin, 4,279. The map shows every state with three or more general hospitals reporting usable square feet; the comparisons in the text use states with 10 or more.

The leanest states, among those with 10 or more hospitals, are Nevada (1,554), Hawaii (1,715), California (2,023), and Florida (2,077). The most building per bed: Wisconsin (4,279), South Dakota (4,161), Iowa (4,074), and Maine (3,858).

Not just bigger hospitals

Small hospitals have more building per bed than large ones, because a hospital needs an emergency department, imaging and a kitchen however few beds it has. The median hospital with under 25 beds has 3,892 square feet per bed; with 200 to 399 beds, 2,320. States full of small rural hospitals should come out high.

But size does not explain the gap. Compare only hospitals of 100 to 299 beds: Nevada's 8 have 1,636 square feet per bed, Wisconsin's 21 have 4,472, 2.7 times as much. California's 145 hospitals of that size have 1,950.

The difference is not at the bedside

The cost report sorts every square foot into one of six groups, so a state's figure can be taken apart. Of the 2,725 square feet per bed that separate Wisconsin from Nevada, patient rooms account for 87, or 3%. The rest is support and overhead (1,014), diagnosis and treatment (694), not billed as patient care (512) and outpatient (408).

One possible reason is what a cost report covers. A hospital that runs its own clinics and physicians' offices reports their space; a hospital whose doctors practice in buildings owned by others does not. The cost reports alone cannot say how much of the gap that explains.

Region by region

Within states, the spread is wider still. Grouping hospitals by the Dartmouth Atlas's hospital referral regions, the areas whose patients go to the same major hospitals, the 232 regions with 4 or more general hospitals run from 1,368 square feet per bed around Santa Rosa, CA to 5,595 around New Orleans, LA.