Hospital 'deserts' a growing problem in major urban centers

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Guest post by Alan Sager

In 1960, 42 acute care hospitals with 8,000 beds served Detroit's 1.7 million residents. But only four hospitals with 2,700 beds survived to serve 700,000 residents in 2010.

All of the survivors are costly major teaching hospitals. Especially in winter, ambulances are sometimes challenged to provide rapid response to the people of a 139-square-mile city whose residential side streets rarely see snow plows. 

Detroit is not alone. Hospital "deserts" are conspicuous--and growing--in broad expanses of St. Louis, Cleveland, Washington, Atlanta, several Texas cities, New York City's boroughs, and elsewhere. 

These findings stem from a study of changes in some 1,200 acute care hospitals in 52 cities over the past 75 years. Of the 774 hospitals open in these 52 cities in 1960, 484 (over three-fifths) had closed by 2010. 

What are the characteristics of the hospitals that survive? Decade after decade, hospitals are more likely to remain open if they are larger teaching hospitals, have more accumulated wealth relative to their size, and are located in neighborhoods that are heavily caucasian. Unexpectedly, hospital efficiency--either alone or after controlling for other factors--has had no value in predicting which hospitals survive.

But aren't these changes just one part of a steady, desirable, and money-saving shift of healthcare from inpatient to outpatient services? Why should we worry or do anything about them?