Causes and Consequences of Urban Hospital Closings and Reconfigurations Pt 1 - Edubirdie

University:
Boston University
Course:
GMS BC 630 | Ethical & Policy Issues in Health and Medical Services Emergency Management
Academic year:

2023
Views:

108

Pages:

22
Author:

pubicswprv

Causes and Consequences of Urban Hospital Closings and Reconfigurations, 1936 - 2010 OVERVIEW A. The terrain B. Identifying the hospitals that are likelier to close C. Why do hospital closings matter? Access, Cost, Quality D. Stabilizing needed hospitals A. The terrain Overview • The care we get depends heavily on the caregivers we’ve got. • The configuration of urban hospital care—location, hospital type, and number of beds—evolves constantly. • Over the decades, smaller and mid-size hospitals, and those located in black neighborhoods, have been much likelier to close. Efficiency confers no survival value. • Patterns differ across cities but consequences for access and cost appear undesirable, on balance. Consequences for quality appear mixed. • Financial, legal, and policy tools can and should be employed to identify and stabilize needed hospitals and ERs. • Why? Why? When? Which? – 1972 - Duncan Neuhauser assigned “Urban Community Hospital in Transition” – hospital adaptations to neighborhood changes – Boeing 707 – “The care we get depends heavily on the caregivers we’ve got.” • When? – 1937 Guide to U.S. and Canadian Hospitals available in Countway – 1940 U.S. Census first compiled tract data for all cities > 50,000 • Which? – All central cities of metropolitan areas with 1,000,000 or more in 1970 – Stratified samples of central cities of smaller metro areas (250-500K + 500K-1M) The 52 cities U.S. Population Density, 2010 Study Hospitals • Follow beds, site of care, not corporate entity • Closing = cessation of acute inpatient care • Non-federal, short-term, acute “general and other special” – Med-surg and other services – Pediatric only – Obstetrical only (now largely obsolete) – Cancer only (now largely obsolete) – Excluding psychiatric-only, rehab-only Hospital Beds by Ownership, 52 U.S. Cities, 1936 - 2010 300,000 250,000 200,000 150,000 Public Non-profit For-profit 100,000 Total 50,000 0 1936 1950 1960 1970 1980 1990 2000 2010 52 cities + U.S.A. are now 1 bed/ 1,000 below 1940 levels Hospital Closings/relocations and New Hospitals by Decade Period Start Closing % Closing Survivors New End Change % Change 1937-50 709 75 11% 634 79 713 4 1% 1950-60 713 81 11% 632 110 742 29 4% 1960-70 742 90 12% 652 122 774 32 4% 1970-80 774 153 20% 621 90 711 -63 -8% 1980-90 711 130 18% 581 50 631 -80 -11% 1990-2000 631 122 19% 509 3 512 -119 -19% 2000-2010 512 87 17% 425 1 426 -86 -17%

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