Wednesday, April 01, 2020

The Falling Number of American Hospitals

Since 1975, while the U.S. population has risen from 216 million people to 331 million, the total number of hospital beds has declined from 1.5 million to 925,000. 

The United States currently has only 2.8 hospital beds per 1,000 residents, just a little over half the average of 5.4 beds per 1,000 residents in other wealthy countries.

In 2018, the American Hospital Association estimated that 30 hospitals will close each year and the number is expected to rise over time.

Rural hospitals are closing the fastest. Over 120 have closed down since 2010. A report by the Chartis Center for Rural Health found another 453 of the 1,844 that remain are at risk of closing. Failing rural hospitals are preyed upon by large corporations that take them over, extract their revenues and then allow them to lapse into bankruptcy and the land sold as valuable real estate. The highest number of rural hospital closures, 19, occurred in 2019. Six rural hospitals have already been shut down this year. Roughly 20 percent of the U.S. population lives in a rural area. Residents of rural areas tend to be older, sicker and poorer than in other areas. They require more care and often can’t pay for it, placing a greater financial burden on local hospitals than populations that are healthier and wealthier.  In general, the Pew Research Center found people living in rural areas travel twice as far as people living in urban and suburban areas to get to the hospital. According to a study by the National Bureau of Economic Research, mortality rates rise by 5.9 percent when hospitals disappear, especially for people with emergencies such as strokes and heart attacks that require immediate attention. 

Hospital closures in cities also tend to occur in areas that serve poor communities and often populations of color. Like rural hospitals, they may be bought by a large corporate hospital system when they are failing and then allowed to go bankrupt. It is often more profitable to redevelop them in a gentrifying area than to keep them open.

When hospitals are located in communities with high numbers of uninsured residents, they are particularly vulnerable to closures. According to the University of North Carolina’s Rural Health Research Program, the 17 states that did not expand Medicaid under the Affordable Care Act had the highest number of hospital closures. Texas lost the most hospitals, followed by Tennessee, Georgia, Alabama, Mississippi and North Carolina. Over half of the remaining rural hospitals in Texas and Tennessee and more than a third of hospitals in Oklahoma and Georgia are at risk of closing due to their weak financial position.

In other cities, hospitals may stay open but close down essential services to make way for more lucrative fields such as orthopedics and cardiovascular disease. MedStar, a Washington, D.C.-based corporation that owns 10 hospitals in Maryland as well as physician practices, laboratories, long-term care centers and other health facilities, abruptly closed whole departments that provided obstetric, pediatric and psychiatric care in recent years.

Epidemiologist David Fisman of Toronto, Canada, says, “having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.”

No comments: