Navigation Links
Economic factors associated with increase in closures of emergency departments
Date:5/17/2011

Over the last 20 years, the number of hospital emergency departments in nonrural areas in the U.S. has declined by nearly 30 percent, with for-profit ownership, location in a competitive market, low profit margin and safety-net status associated with an increased risk of emergency department closure, according to a study in the May 18 issue of JAMA.

"As the only place in the U.S. health care system that serves all patients, emergency departments (EDs) are the 'safety net of the safety net.' Federal law requires hospital EDs to evaluate and treat all patients in need of emergency care regardless of ability to pay," according to background information in the article. "Between 1998 and 2008, the number of hospital-based EDs in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures."

Renee Y. Hsia, M.D., M.Sc., of the University of California, San Francisco, and colleagues conducted a study to examine the factors that may be associated with the closure of hospital EDs. The study included emergency department and hospital organizational information from 1990 through 2009, acquired from the American Hospital Association Annual Surveys and merged with hospital financial and payer mix information available through 2007 from Medicare hospital cost reports.

The researchers evaluated 3 sets of risk factors: hospital characteristics (safety net [as defined by hospitals caring for more than double their Medicaid share of discharges compared with other hospitals within a 15-mile radius], ownership, teaching status, system membership, ED size, case mix), county population demographics (race, poverty, uninsurance, elderly), and market factors (ownership mix, profit margin, location in a competitive market, presence of other EDs).

The researchers found that from 1990 to 2009, the number of hospitals with EDs in nonrural areas in the U.S. decreased from 2,446 to 1,779, a decline of 27 percent, with an average of 89 closing per year. Over an 18-year study interval (1990-2007), EDs that closed were more likely to be at for-profit hospitals than EDs that remained open (26 percent vs. 16 percent). Smaller facilities were more likely to close their ED; and twice as many hospitals that closed their EDs were in the lowest quartile of the profit margin distribution, compared with those that kept their EDs open. Emergency departments that closed tended to be located in counties with high shares of minority populations (36 percent vs. 31 percent), high shares of populations in poverty (37 percent vs. 31 percent), and more than 15 percent of its individuals without insurance (42 percent vs. 36 percent). Thirty-four percent of EDs that closed were in highly competitive markets, compared with 17 percent of those with EDs that did not close.

Adjusted analysis indicated that three hospital-specific characteristics were associated with an increased risk of ED closures, including safety-net status, for-profit status (compared with not-for-profit or government hospitals), and hospitals with profit margins in the lowest quartile. And after fully adjusting for all factors in the model, EDs in communities with the highest percentage of population in poverty were at increased risk of closure. Also, presence of another ED within a 15-mile radius was associated with increased risk of ED closure, and hospitals in areas with high levels of competition were at higher risk of closure.

"Our findings underscore that market-based approaches to health care do not ensure that care will be equitably distributed. In fact, the opposite may be true. As long as tens of millions of Americans are uninsured, and tens of millions more pay well below their cost of care, the push for 'results-driven competition' will not correct system-level disparities that markets cannot and should notbe expected to resolve," the authors write.

"It is critical to determine whether and how to engage society in decisions to maintain or close EDs and other safety-net services."


'/>"/>

Contact: Karin Rush-Monroe
Karin.Rush-Monroe@ucsf.edu
415-502-1332
JAMA and Archives Journals
Source:Eurekalert

Related medicine news :

1. Neighborhood socioeconomic status and diabetes
2. Majority of Americans Approve of President Obamas Handling of Afghanistan and National Security But Disapprove of Handling of Economic Issues, Per Franklin & Marshall College Poll With Hearst Television
3. Mayo Clinic responsible for $22 billion in economic impact, including $9.6 billion in Minnesota
4. Census Bureau News -- 2007 Economic Census: Health Care and Social Assistance Geographic Area Series (NAICS 62)
5. Shortage of Black Doctors Rooted in Social, Economic Ills
6. U.S. Senate Urgently Needs to Extend Medicaid Match in Economic Recovery Legislation
7. Gilsbar's Health & Lifestyle Management Program Wins First Place Award at the National Workforce Health Economics Summit
8. Zimmer Receives Recognition for Health Economics Data Presented at 77th Annual American Academy of Orthopaedic Surgeons Meeting
9. Late-stage melanoma results in economic burden
10. Yondelis(R) Receives Five New Approvals Outside the European Economic Area
11. Statement of Ralph B. Everett, President and CEO, Joint Center for Political and Economic Studies, on House Passage of Health Reform Legislation
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... June 25, 2016 , ... ... recover from injury. Recently, he has implemented orthobiologic procedures as a method for ... is one of the first doctors to perform the treatment. Orthobiologics are substances ...
(Date:6/25/2016)... ... June 25, 2016 , ... Conventional wisdom preaches the benefits of ... of the latter, setting the bar too high can result in disappointment, perhaps even ... progress toward their goal. , Research from PsychTests.com reveals that behind ...
(Date:6/24/2016)... Marne, Michigan (PRWEB) , ... June 24, 2016 , ... ... To deal with these feelings, many turn to unhealthy avenues, such as drug or ... Center of Marne, Michigan, has released tools for healthy coping following a traumatic event. ...
(Date:6/24/2016)... ... ... Marcy was in a crisis. Her son James, eight, was out of control. Prone to ... , “When something upset him, he couldn’t control his emotions,” remembers Marcy. “If there ... my other children and say he was going to kill them. If we were ...
(Date:6/24/2016)... ... ... Global law firm Greenberg Traurig, P.A. announced that 20 Florida attorneys are recognized ... this recognition are considered among the top 2 percent of lawyers practicing within the ... this year’s Legal Elite Hall of Fame: Miami Shareholders Mark D. Bloom, Burt ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... Dublin ... of the " Global Markets for Spectroscopy Equipment" ... This report focuses on the global ... including its applications in various applications. The report deals ... three main industries: pharmaceutical and biotechnology, food and beverage, ...
(Date:6/24/2016)... Research and Markets has announced the addition of the ... to their offering. ... World Market for Companion Diagnostics covers the world market for ... report includes the following: , World IVD ... (N. America, EU, ROW), 2015-2020 , World IVD Companion ...
(Date:6/23/2016)... , June 23, 2016  MedSource announced ... as its e-clinical software solution of choice.  This ... best possible value to their clients by offering ... The preferred relationship establishes nowEDC as the EDC ... for MedSource,s full-service clients.  "nowEDC has long been ...
Breaking Medicine Technology: