Why Hospitals Matter


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For many of us, hospitals represent an important community resource – a place to go when illness reaches a dangerous stage, or an emergency requires immediate and expert care.  But hospitals play a complex and integral role in our overall health care system.  Aside from the life-saving emergency and acute care they are equipped to provide, they also serve as a glue that binds health care services to an area.  When facilities are forced to shut down or merge, often that glue dissolves, leaving patients without the care they need. 

Because historically those responsible for such closures have not considered how much communities rely on their hospitals, or what will replace them when they are gone, closures have produced dire results for many communities throughout New York.  Therefore, any health care decisions should be based on the principle that they first do no harm.  We need to stop closing hospitals before we have a satisfactory planning system in place that ensures that the hospital-based services New Yorkers rely on will still be accessible.

Many New Yorkers rely on clinics affiliated with hospitals for care.

When hospitals close, affiliated clinics and doctors’ offices also shut their doors – leaving communities without emergency and preventive care. 

• In New York State, hospital clinics accounted for more than 15 million outpatient visits in 2004.  
• When hospitals close, it takes many patients months or years to navigate the system and find new doctors; 30% of patients simply stop receiving inpatient care.  

Proximity to a hospital is important to many residents’ ability to maintain good health.

Hospital closures mean that certain communities must travel great distances to reach the nearest hospital.  Distance from such facilities is not merely an inconvenience.  Research shows that with every mile between a patient and a hospital, there is approximately:

• A 3 % decline in the probability that a child has had a checkup;  
• A 6.5 % increase in the number of deaths from heart attack;
• An 11 to 20 % increase in the number of deaths from unintentional injures.”

Hospitals are crucial to the health of the most vulnerable New Yorkers. 

When hospitals close or downsize in a community, low-income and communities of color are hit the hardest.

• In New York City, 32% of the primary care physicians who see patients on Medicaid are based in hospitals.  
• Without the hospital-based supply of primary care physicians, 95% of city zip codes would be designated as either having a “serious shortage” of primary care physicians or as being “stressed” under the federal Health Resources and Services Administration’s guidelines for population to physician ratios.  
• Federal and state laws require hospitals to provide interpreter services where needed, and to post signs in multiple languages.   Individual providers and small clinics not affiliated with hospitals are not under the same obligations.   And hospitals are far more likely to have the economies of scale necessary to serve a range of patients with limited English proficiency. 
• Hospital closings impose significant burdens on people with disabilities who, as a result of their disability, often require more health care than people without disabilities.  People with mobility impairments, moreover, are significantly disadvantaged by the closing of a local health facility, given the added burden of traveling to a more distant facility. 

The state repeatedly fails to give public need adequate weight in closure decisions.

Historically, the closure of hospitals has most hurt medically underserved and communities of color.

• Over the past 40 years, hospitals in New York City have primarily closed in medically underserved areas and areas with high rates of poverty. 
• Two-thirds of the 12 hospitals that closed between 1995 and 2005 in New York City – each time with the approval of New York State’s Department of Health – served predominantly people of color.  In some cases, the patient populations served by those hospitals were more than 90% African American, Latino, and Asian American.
  

Conclusions

While hospitals are not the only source of health care for New Yorkers, they play a pivotal role in our health care system.  They provide crucial services and infrastructure, much of which is unique to hospitals.  They serve as anchors – and often as magnets – for other related services.  And for many residents, they are in fact the main source of care for preventative as well as emergency services. 

The State’s procedure for approving hospital and clinic openings and service cuts has left many New York City residents without basic health care services in their communities, in violation of domestic and international law.  Any further service cuts or hospital closures may exacerbate those violations, leaving New Yorkers with even fewer resources and with worse health outcomes.

Endnotes

1.   Sara Rosenbaum et al., Laying The Foundation: Health System Reform in New York State and the Primary Care Imperative 19-20 (2006), at http://www.chcanys.org/index.php?src=news&prid=13.
2. Alan Sager, quoted in Joshua Brustein, Hospitals in Crisis, Gotham Gazette, Sep. 26, 2005, at http://www.gothamgazette.com/print/1600; see also Alan Sager, quoted in Mike McPhate, City Hospital Crisis: Residents Fear Closures Will Target Minorities, Resident Publications, Nov. 8, 2006, at http://70.47.124.114/taxonomy/term/1.
3. Janet Currie & Patricia Regan, Distance to Hospital and Children’s Use of Preventive Care: Is Being Closer Better, and For Whom?, 41 ECONOMIC INQUIRY 3, 2003 at 378-91.
4. Thomas C. Buchmueller et al., How Far to the Hospital? The Effect of Hospital Closures on Access To Care, JOURNAL OF HEALTH ECONOMICS 25, 2006 at 740-761.
5. Id. 
6. See Nancy Lager et al., The Primary Care Development Corporation & the New York City Health and Hospital Corporation, A Primary Care Shortage in New York City and the Potential Impact of Hospital Closures 2 (Sept. 2006), at http://www.nyc.gov/html/hhc/downloads/pdf/pcdc-report.pdf.
7. Id.
8. See Executive Order 13166 of Aug. 11, 2000, 65 Fed. Reg. 50121 (Aug. 16, 2000) (directing recipients of federal assistance to “take reasonable steps to ensure meaningful access to their programs and activities by LEP persons”), at http://www.usdoj.gov/crt/cor/Pubs/eolep.pdf; see Department of Health and Human Services, Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, 68 Fed. Reg. 47311 (Aug. 8, 2003), at http://www.usdoj.gov/crt/cor/lep/hhsrevisedlepguidance.pdf; see 10 NYCRR §§ 405.7(7), 751.9 (2006); see also The New York Immigration Coalition, Policy Update, State health regulation requires hospitals to improve communication with patients:  Civil rights complaints bring about reforms, Sept. 13, 2006, at http://www.thenyic.org/templates/documentfinder.asp?did=592.
9. Telephone interview with Ivana Begic, Health Coordinator, RACCOON (Oct. 12, 2006); interview with Theodoro Oshiro, Government Benefits Advocate, Make the Road by Walking, Brooklyn, NY (Nov. 2, 2006).