Medicare Compliance & Reimbursement

The wealthier the community, the better the care access, a study finds.

Public hospitals have long been a health care safety net for poor urban and suburban communities, whose residents don't have health insurance or the money to pay steep medical bills. But this safety net may be a thing of the past if public hospitals keep shutting down, says a recent report released by the State University of New York Downstate Medical Center.

Between 1996 and 2002, more than twice the number of public hospitals closed than did for-profit and non-profit facilities in both the cities and suburbs, according to the Robert Wood Johnson Foundation-funded study, "Hospital Care in the 100 Largest Cities and Their Suburbs, 1996-2002: Implications for the Future of the Hospital Safety Net in Metropolitan America."

Other findings show that urban public hospitals provided less inpatient and emergency care in 2002 than in 1996. For-profit hospitals now surpass public facilities in total admissions for the 100 largest U.S. cities, even though most public hospitals typically care for seriously ill patients who require longer stays, according to the study. Public hospitals may become an endangered species, said Dennis Andrulis, PhD, lead study author, formerly of SUNY Downstate Medical Center and now with Drexel University School of Public Health. "Not only are public hospitals disappearing from inner cities across the country, they are disappearing from the suburbs as well."

News that poor communities have the highest rates of uninsured and underinsured is not new, but this study found that the lack of coverage might be driving many hospitals to wealthier areas.
 
For instance, among the metropolitan areas studied, high-poverty suburbs made up 44 percent of the total suburban population in 2000, but they accounted for only 20 percent of total admissions, inpatient stays and outpatient and emergency visits in 2002.

Yet, in those same years, low-poverty suburbs comprised 26 percent of the population but had more than 40 percent of all suburban hospital admissions, outpatient and emergency department visits.

"While we all may read more about the impact of public hospital closures on inner cities, the fact is we are also seeing the potential for an impending crisis in suburbs with high-poverty populations," Andrulis said. "These high-poverty suburbs exist disproportionately in California, Texas and other areas in the south." 

Hospitals need to address how their safety net will adapt to meet the health care needs of our poorest and sickest residents, he said. "As the number of public hospitals continues to decline, the concern remains to what extent non-profit and for-profit hospitals are taking or will take on greater responsibilities as safety net providers, and to what degree their focus is on attracting the healthiest of Medicaid patients, leaving the sickest and costliest patients to the care of the remaining public or major safety net hospitals," he added.