A public hospital closes: impact on patients' access to care and health status

Article Abstract:

Hospital closings have multiplied because of excess hospital beds nationwide and soaring health care costs. Some suggest that hospital closings represent the survival of better-quality hospitals and elimination of the worst. However, others report that threatened or closed hospitals are more likely to be those serving poor and underinsured patients, especially in rural or nonwhite urban areas. Public, nonfederal hospitals are at higher risk of closing, and many are located in rural areas. Access to health care for poor and minority citizens has declined during the last decade, causing negative health effects. However, many officials claim that no direct evidence demonstrates that access to medical care is disrupted or patients suffer when public hospitals close. In northern California, the effects of a semirural hospital closing on patients' access to health care and their health status were evaluated. A total of 219 subjects from Shasta, the closed hospital, and 195 from San Luis Obispo (SLO), a public semirural hospital in central California, answered a questionnaire; 191 and 173, respectively, were available to complete a follow-up questionnaire one year later. The Shasta County population included more whites and Native Americans, while more Hispanics obtained care at SLO. Although more patients from SLO were employed and their average household incomes were higher, the group included more people without health insurance. Over the one-year study period, the percentage of people in Shasta County without a health care provider doubled (from 14 to 27.7 percent); this was most apparent among those who had Medicaid or no insurance. Due to financial constraints and the number of physicians who refused Medicaid coverage, the percentage of Shasta County citizens who were denied medical care rose from 10.8 to 16.9 percent. More Shasta patients waited longer than a week for medical care and missed medications. Patients at SLO experienced improved access to health care with regular clinicians and no change in the level of care denied. Compared with the SLO group, patients in Shasta had significant decreases in four measures of public health: health perception, social function, role function, and pain. These findings suggest that, despite a remaining nonprofit and for-profit hospital in the region, patients from the closed public hospital suffered declines in access to outpatient and inpatient medical care, and health status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Economic aspects, Poverty, Poor, Rural health services, Hospital closures, Regional medical programs

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Consequences of queuing for care at a public hospital emergency department

Article Abstract:

Emergency rooms provide the only source of medical care for many of the nation's poor and uninsured. Some private hospitals have closed the doors of their emergency rooms to prevent access to their facilities by the poor, and many such patients are transferred to the emergency rooms of public hospitals. As a result, the patient load of many public hospital emergency rooms has grown tremendously over the past decade. This increase in the number of patients has led to an increase in the amount of time the average patient must wait. This, in turn, has led to an increase in the numbers of patients who leave the emergency room before a physician has had the chance to see them. A study was undertaken to determine the extent of this problem and the consequences that leaving prematurely might have for the health of the patient. A total of 700 patients who waited for emergency room care during a one-week interval participated in the study; 85 percent eventually saw a physician and 15 percent left without being seen. These proportions seemed to be about the same for all patients regardless of sex, age, or ethnic group. As might be expected, the longer the waiting time, the more likely patients were to leave without seeing a physician. The median waiting time for the patients in the present study was almost three hours; the longest wait was 17 hours. On the average, the patients who left would have waited a 52 minutes longer to see a physician than did the patients who actually saw a physician. Of the patients who left, 4 percent required subsequent hospitalization and 27 percent returned to an emergency room. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Hospitals, Hospital emergency services, Hospital outpatient services, Triage (Medicine)

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The role of black and Hispanic physicians in providing health care for underserved populations

Article Abstract:

The dismantling of affirmative action programs may reduce access to health care for the poor and minorities. Researchers used Census data to analyze the racial distribution of 394 California communities and data from the American Medical Association to determine the number of physicians practicing in those areas. The lowest number of physicians per 100,000 people occurred in areas with large numbers of black and Hispanic residents. This was true in urban and rural areas. A survey of 718 primary care physicians in 51 California communities found that black physicians practiced in areas with a high percentage of Blacks and cared for almost six times as many Blacks as other physicians. They also cared for more Medicaid patients than other physicians. Hispanic physicians practiced in areas with a high percentage of Hispanics and cared for almost three times as many Hispanics as other physicians. They also cared for more uninsured patients. Black and Hispanic physicians may be filling an important role in underserved areas.

Care and treatment, Practice, Physicians, Medical professions, Ethnic groups

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