Rethinking Healthcare

Why hospital ERs are on the decline

Why hospital ERs are on the decline

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Over a 20-year period, more than 25 percent of all emergency rooms in the United States closed or went out of business. Why? We spoke to researcher Renee Hsia.

A new study from the Journal of the American Medical Association showed that, "from 1990 to 2009, the number of emergency rooms in the U.S. fell from 2,446 to 1,779 - a 27-percent decline,” according to our sister site CBSNews.com.

I spoke with researcher Renee Hsia about her findings. Below is an excerpt of our conversation.

SP: What did you find in your study?

There are two main findings of our study. One finding is that over a 20-year period, over a quarter of ERs closed, or went out of business. That means we have fewer ERs, which means more overcrowding in the ERs. We have good evidence to show that more crowding means poorer care, and ultimately, a poorer outcome for patients. The second finding is that there are certain risk factors for closure. If your hospital is low profit margin, then you’re more likely to close. But there’s also market factors related to closure. If you’re a for-profit hospital, or if you’re located in a competitive hospital market environment, then you’re also more likely to close.

SP: What kinds of characteristics make an emergency room department more likely to close?

One factor is that if you’re a hospital that serves a high safety net population. We defined safety net as patients that are poorly insured, specifically Medicaid. Hospitals that serve a high proportion of patients in poverty have a forty percent higher hazard of closing.

SP: Why is this so important for the patient?

If there are fewer emergency rooms providing care, this means you have to wait longer and longer.We have evidence to show that the demand for ERs is rising. Even though we have fewer ERs, the number of visits has increased over 35 percent, while our supply of ERs has decreased by 27 percent. The numbers are going in opposite directions.With decreased resources, everyone is going to experience the effects of overcrowding.

SP: What does this mean for healthcare in the future?

What we showed in our study is that in the past 20 years, this is what has occurred. We have a decline in the supply, and an increase in the demand. Emergency rooms are the only place in the US healthcare system where we provide care to everybody, regardless of their ability to pay. But if there’s not a system in place to pay for that care, then the consequences we see are closures.

SP: Is there a way to prevent hospital ERs from closing?

We need to simplify the way we as a society pay for healthcare. If you don’t have an emergency room in your community, it doesn’t mean that emergency disappears. It means that you go to the nearest available emergency room. We aren’t isolated in our need for emergency care.

Photo: Renee Hsia

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Stacy Lipson

Contributing Writer

Contributing Writer Stacy Lipson has written for Natural Health, MSNBC's Body Odd, HealthDay.com, Sprig.com, BNET.com, MarieClaire.com, MyDaily.com and Lemondrop.com. He holds a degree from Temple University. She is based in New York. Follow her on Twitter. Disclosure