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

Page: 1 2 3

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