The 2010 Patient Protection and Affordable Care Act (PPACA) represents the culmination of a shift in thinking about healthcare delivery in the United States. PPACA and its push for Accountable Care Organizations (ACOs) is moving the US healthcare system towards integration. With the downward push in costs and incentives for quality and efficiency, mergers and acquisitions in the healthcare industry are likely to ramp up in the next decade. The formation of ACOs and the increasing consolidation of healthcare organizations present a number of questions, policy, legal, equity, etcetera.
One of the more important and often underrepresented issues in the media is the disappearing of America’s safety net hospitals. These are the hospitals that serve many of our country’s vulnerable populations and provide essential health services. There are 2,700 safety net hospital in the United States. Without these hospitals, many of these communities would not have local healthcare services. Safety net hospitals are responsible for taking care of many of the US’s uninsured, Medicaid, racial/ethnic minorities and rural patients. (Meyer, 2004) Cost control, quality and efficiency standards could have an inequitable effect on the US population, where the communities served by safety net hospitals get an unfair portion of hospital closures, and thus are left without sufficiently reasonable healthcare access.
Gloria Bazzoli, et al. in their recent study (Feb, 2012) in the Journal of Health Services Research, entitled “The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services,” examined the effects of safety net hospital closures on uninsured, Medicaid, and racial/ethnic minorities. They looked at patients’ travel distances, through a framework of consumer search decisions and hospital choice. They also accounted for patient characteristics that affect perceived travel costs and benefits (i.e. traveling an hour for life saving emergency care versus traveling an hour for primary care). Bazzoli, et al. found that Safety Net Hospital closures “appear to have detrimental access effects on particular subgroups of disadvantaged populations.”
While there were several limitations to this study, it still raises important policy implications. Policy makers should make an effort to address the needs of these marginalized populations if it happens that their Safety Net Hospital closes. Services relating to transportation to and from health care centers may be the ideal way to deal with health services disruptions. On the other hand, this is a mitigating step, and perhaps we should first be asking the question, do we want our healthcare to be further away from home? What are the benefits and what do we lose when we choose high quality, high efficiency and lower cost healthcare over community-focused healthcare? This is obviously not an either/or question but rather what should be considered when discussing policy implementation. This an issue that should be considered by both urban and rural dwellers, as Safety Net Hospitals are located in communities of varying population densities. However, I would argue that a healthy population cared for in an equitable way is in all of our best interest.
The future of healthcare organization shows a trending towards increased integration and regional health systems in the hopes of achieving greater efficiencies, higher quality and lower costs in our healthcare system. The effect of this trend could see safety net hospitals disappear as they will be forced through financial pressures to either merge with larger health systems or shut their doors.
Gloria J. Bazzoli, Woolton Lee, Hui-Min Hsieh, and Lee Rivers Mobley (Feb, 2012). “The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services.” In Health Services Research, 47:11.