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Hospitals in Older Cities Close Down, Blacks Worst Affected

view's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved.

Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers.

"This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."

New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation.

But few cities have been hit as hard as Detroit.

The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.

Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998.

"Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."

Riverview finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red.

Medicare payments to ho
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