Dozens of hospitals have closed in the past decade. Operating revenues at many hospitals have dropped, particularly in rural areas with high rates of uninsurance. Part of the reason is due to a lack of need: Hospitalizations have trended downward for years.
The supply of hospital beds is higher than the demand, especially in rural areas, said Karen Joynt Maddox, assistant professor at Washington University School of Medicine and a practicing cardiologist.
"We just don't need as many hospitals as we used to," Maddox said.
Hospitals are increasingly merging to save money and gain more negotiating power with insurers. But, these savings rarely apply to rural hospitals, making them less attractive targets in mergers.
As a result, many local hospitals have closed, which can affect some patients' health and finances.
When hospitals close, patients have to travel farther. This isn't always bad. Maddox helped conduct a study of 195 hospital closures that took place between 2003 and 2011.
The authors found no significant difference in death rates for patients living in places where hospitals closed. Maddox said the study found the hospitals that closed did so for a reason — they were struggling financially and health outcomes suffered as a result.
"For many patients, an increased drive time would be offset by showing up at a hospital that was doing better," Maddox said.
But those trade-offs may change as more hospitals close and patients must travel farther. As distances increase, visiting a hospital becomes more of a time sink. Having to secure transportation can keep people from getting care altogether, said Caitlin Donovan, a spokeswoman for the National Patient Advocate Foundation, and people may be more likely to need to book a hotel and buy food for the trip.
Closing a hospital can impact a range of people, from older patients with chronic conditions who need constant care, to low-income people who rely on emergency services. It can also affect your budget. The next-closest hospital and any new doctors you see may be out of your health insurance network. This can raise out-of-pocket costs. (Follow these nine tips to lower your out-of-pocket costs.)
When hospitals close, people lose out on services like prompt emergency and obstetric care. But they often also lose the medical establishment surrounding the hospital, which can include mental health and primary care professionals, Maddox said. These services often follow hospitals out of town when they close.
Hospitals often support non-medical businesses in a community as well, from delivery services to restaurants to cleaning services.
"Sometimes hospitals are a community anchor in an economic sense," Maddox said.
Urgent care may fill some of the gaps left by a shuttered hospital emergency room. In addition, many services like imaging, lab work and some cancer treatment take place at outside facilities. But a minute clinic or lab can't stabilize someone who's gone into labor, Maddox said.
Some hospitals leave their emergency departments open when they close, especially if they're part of a health system. This way they can treat local patients promptly and send them to other hospitals in the system if they need further care, Maddox said. But for patients who need serious emergency treatment, a longer trip to the hospital is the only real option.
The factors closing hospitals, from lower hospitalization to industry consolidation, still exist, Maddox said. Hospitals will likely keep closing, though some of this trend will be offset by the aging population. One way states can slow the trend is to expand Medicaid.
Closures are lower in states that expanded Medicaid to cover all low-income residents, Maddox said. More people have access to care and take advantage of that access.
"When Medicaid expands," Maddox said, "you not only end up with hospitals getting more bills paid, but it probably also drives more volume."
Image: Carles Rodrigo Monzo
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