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November 13, 2013

More hospitals are closing—and it's creating medical deserts

Daily Briefing

As more hospitals close, "medical deserts" are cropping up and compromising access to care even as the Affordable Care Act (ACA) expands access to health insurance, U.S. News & World Report's Joseph Williams reports.

Over the past few years, changing health care economics and demographic trends have prompted hospital closures everywhere from small rural communities that struggle with access to care to urban areas that struggle with high populations of uninsured residents. According to Alan Sager, a Boston University health policy professor, the epidemic is like the melting of a glacier—nearly invisible on a daily basis, but "over time, you can see big changes."

Wellmont closes hospital over Medicare cuts, refusal to expand Medicaid

According to the Office of Rural Health Policy, 640 U.S. counties are without quick access to an acute-care hospital—or about 20% of the nation's 29,000 residential areas. These medical deserts exist in cities such as Detroit, Los Angeles, and Washington, D.C., as well as rural areas of Texas, Georgia, and Mississippi, Sanger says.

And the trend will continue to "escalate" in spite of the ACA, according to Brian Smedley of the Joint Center for Political and Economic Studies. Smedley notes that underserved, rural communities are more likely to suffer.

"[W]e're in a situation where we're trying to expand health care on top of a model that's inefficient," says Smedley, adding that "clearly, we're all going to pay for the cost of uncompensated care."

For states not expanding Medicaid, DSH cuts will deal a tough blow

Moreover, when hospitals close, their EDs close, too—compounding the problem of overcrowded EDs, according to the American Hospital Association's Caroline Steinberg. This means longer wait times for patients in critical health, as well as reduced access for the chronically ill or those that rely on the ED for primary care (Williams, U.S. News & World Report, 11/8).

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