WEDNESDAY, Aug. 17, 2005 (HealthDay News) -- While many hospitals in the suburbs surrounding the country's largest cities have closed their doors in the past decade, a new study finds that public hospitals, which typically serve the poor, have been hit the hardest.
Researchers at SUNY Downstate Medical Center in New York City report that about 27 percent of public hospitals in the suburbs of large cities and 16 percent of public hospitals in cities have closed between 1996 and 2002, leaving a potentially serious gap in the availability of health care for the vulnerable populations that rely on these hospitals for their medical needs.
"This report is a wake-up call. There should be real concerns about availability of hospital-based safety net care, especially in high-poverty suburban areas," said study author Dennis Andrulis, director of the Center for Health Equality at the Drexel University School of Health in Philadelphia. He conducted the study while working at SUNY Downstate.
"We have a shrinking number of [public] facilities, and there is a need for a concerted effort to assess the shape and responsibility for a safety net among the nonprofit and for-profit hospitals," he added. "If we don't, we might see a 'leave-it-to-the-market' effect that could pose some real threats to vulnerable populations."
The results of the report, Hospital Care in the 100 Largest Cities and Their Suburbs, 1996-2002, which was funded by the Robert Wood Johnson Foundation, are published on the SUNY Web site.
Of the three types of hospitals reviewed in the six-year study -- nonprofits, for-profits and public hospitals -- the nonprofits formed the largest group (1,094). Their number declined by 11 percent in the cities and 2 percent in the suburbs, dropping to 1,027 by 2002. For-profit hospitals (325) had a drop of 11 percent in both cities and their suburbs, leaving only 289 by 2002. As for public hospitals, there were 217 in 1996 and only 168 by 2002.
The report showed that for-profit and nonprofit hospitals were caring for more Medicaid patients in 2002 than in 1996, but that public hospitals still take in more of these patients than do the other two types of hospitals (31 percent compared to 20 percent in for-profit hospitals and 18 percent in nonprofits). Further, public hospital patients have a longer average length of stay than do patients in other hospitals, suggesting that they are relatively sicker and thus more costly to treat.
Andrulis said the report illuminated the growing problems of providing health care to poorer populations in the suburbs. The number of public hospital closings in those locales -- nearly double the number of closings of city public hospitals -- means people there face serious roadblocks in getting care.
"If you are a poor person living in a high-poverty suburb, you are going to have a lot of trouble getting to care," he said.
He said that while high-poverty suburbs made up 44 percent of the total suburban population in 2000, they accounted for just one-fifth of total admissions, inpatient days and emergency visits in 2002.
Further, these suburbs had, on average, five times the percentage of Hispanic residents as low-poverty suburbs (26.4 percent vs. 5.3 percent), and surveys have documented this group as having one of the highest uninsured rates in the country, which could be a contributing factor to the poor use of hospital facilities in poor suburbs.
In comparison, people living in low-poverty suburbs comprised only 26 percent of the total suburban population in 2000, yet accounted for more than 40 percent of all suburban hospital admissions, outpatient and emergency visits that took place in these areas in 2002.
"This is an undersupply problem in a population that has a greater need. The report shows that the closing of public hospitals, which tend to serve these populations, leaves behind no one to pick up the slack," said David Schulke, executive vice president of American Health Quality Association, a nonprofit that helps hospitals measure quality of care.
More information
The report can be found at SUNY Downstate Medical Center.
