Thread: 1 out of 3 hospital ERs have closed over last two decades

Study: 1 out of 3 hospital ERs have closed over the last two decades

By Mary Brophy Marcus, USA TODAY
Updated 23m ago


Close to a third of emergency departments closed shop over the last two decades, a new study shows.

Between 1990 and 2009, the number of hospital emergency departments in non-rural areas in the USA declined by 27%, according to a study in Wednesday's Journal of the American Medical Association.

"That's a hefty number, and more than I expected," says study author Renee Hsia, an assistant professor of emergency medicine at the University of California, San Francisco.

Hsia says she and colleagues did a "survival analysis," much like researchers do for breast cancer patients. "In our study, we used the ER as the patient," says Hsia.

They found that the number of emergency departments dropped from 2,446 to 1,779 — an average of 89 closings per year. The figure included only non-rural locations since those in rural areas generally receive special funding from federal sources.

Hsia says researchers also wanted to examine the factors that led to closings. "Certain hospitals are at higher risk for losing their ERs than others," she says. ERs shut down were more likely to:

•Have low profit margins;

•Serve patient below the poverty level;

•Serve patients with poorer forms of insurance, including Medicaid;

•Be for-profit hospitals;

•Reside in more competitive markets;

Emergency experts aren't surprised by the shrinking ER trend.

"It isn't shocking. Health care is a business and certainly health care parallels the course of small business needing larger corporate affiliations to survive," says Carl Ramsay, chairman of emergency medicine at Lenox Hill Hospital, in New York City.

Hsia says it's very concerning that during the same period of time that number of ERs has decreased, there's been a 35% increase in ER visits.

"The demand for care has increased and has rapidly outpaced our supply. They're going opposite directions," she says. Other studies show that the more crowded emergency departments become, the less able they are to give optimal care, and remain America's healthcare's "safety net," she says.

It's a myth that ERs are sucking the healthcare system dry, says Sandra Schneider, president of the American College of Emergency Physicians. "About 92% of patients who come to ERs have to be there. So you're not going to get the money you need by closing emergency departments," Schneider says. She says studies show only 2% of total healthcare costs occur in emergency medicine, while treating obesity-related illnesses is linked to 20% of costs, and hospital readmission rates are linked to 15%.

"The ER is the bird's eye perspective of the whole healthcare system. If we really want a better system, not just band-aid solutions, we need to look at how to simplify the way we pay for health care," says Hsia.

http://yourlife.usatoday.com/health/hea ... 47264082/1

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•Have low profit margins;

•Serve patient below the poverty level;

•Serve patients with poorer forms of insurance, including Medicaid;

•Be for-profit hospitals;

•Reside in more competitive markets;

Emergency experts aren't surprised by the shrinking ER trend.

No direct connection made between the closures and illegal immigration. Furthermore, the article failed to mention that the majority of the closures are coming from states known to have the largest populations of illegal aliens. For example, scores of California hospitals have shut down their emergency rooms or closed entirely in the last decade.