Causes and Consequences of U.S. Urban Hospital Closings and Reconfigurations, 1936 – 2010
Alan Sager
Boston Univ. School of Public Health
Alan Sager specialized in health in graduate school because it looked like the easiest sector in which to win affordable equity for all Americans since so much money was already spent on medical care. (Not easy-just easier than anything else.) His main interests are health reform, combining universal coverage with cost control, improving both finance and delivery, and preserving needed physician, hospital, and long-term care services. He has studied causes and effects of urban hospital closings, finding a strong and persistent link between race of the people living near a hospital and the probability of closing. Policy and research interests include equal access to health care, cost control, hospital survival, long-term care, health reform. Alan holds a B.A. in economics from Brandeis and a Ph.D. in city and regional planning (specializing in health care) from MIT.
Abstract
Background: Public and private actions have long sought to close U.S. hospitals and cut beds in hopes of containing cost without harming access. Because these actions’ effects have not been adequately measured, it's... [ view full abstract ]
Background: Public and private actions have long sought to close U.S. hospitals and cut beds in hopes of containing cost without harming access. Because these actions’ effects have not been adequately measured, it's important to document changes in hospital configuration—beds, teaching status, and location, learn predictors of closings, and assess effects of closings.
Methods: We tracked all 1,216 non-federal acute hospitals in 52 cities in 1936, 1950, 1960, 1970, 1980, 1990, or 2000. Hypothesized predictors of closing included hospital characteristics (beds, teaching status, operating margin, wealth, efficiency), demography of nearby residents, and inter-hospital competition. We analyzed predictors of closings and also examined closings' effects over 75 years.
Results: Hospitals rose from 717 in 1936 to 782 in 1970 but fell by 45% to 426 in 2010. Logistic regressions accurately distinguished hospitals that closed from survivors during the subsequent one, two, and three decades. The c-statistics for seven periods’ logistic regressions averaged 0.796, straddling the border between acceptable and excellent discrimination. Cost of hospital care in the 52 cities in 2010 was 21.8 percent ($11.7 billion) higher than if the 1980 hospital configuration persisted to 2010 because more efficient hospitals were likelier to close and because costly large teaching hospitals were likelier to survive. Hospitals in Black areas were consistently likelier to close, cumulatively reducing Blacks’ access to inpatient and ambulatory care.
Conclusions: Efforts to close hospitals accelerated closings; they did not save money or protect access. For these reasons, because these changes don’t stem from free market competition, and because the health care we get depends heavily on the caregivers we’ve got, it would be useful to identify which hospitals are needed to protect the health of the public, and to ensure they are paid enough to finance efficient provision of needed care.
Authors
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Alan Sager
(Boston Univ. School of Public Health)
Topic Areas
Prevalence and drivers of overuse , Oversupply of providers (e.g. hospitals, physicians, etc) and technologies (e.g. imaging,
Session
AS-1B » Abstract Slams: Education & Policy (12:00 - Friday, 5th May, Salons 6, 7, & 8)
Presentation Files
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