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Hospital Care May Be Severely Limited In High Poverty Suburbs

Armen Hareyan's picture

Health Care Safety

A new report, Hospital Care in the 100 Largest Cities and Their Suburbs, 1996-2002: Implications for the Future of the Hospital Safety Net in Metropolitan America, released today from State University of New York (SUNY) Downstate Medical Center, sheds new light on the struggle to meet the health care needs of all communities across the nation.

More public hospitals were lost between 1996 and 2002 (16 percent in cities and 27 percent in the suburbs) than for-profit (11 percent in cities and 11 percent in suburbs) and non-profit hospitals (11 percent in cities and 2 percent in the suburbs), a stark contrast to the relatively moderate decline in the number of hospitals nationwide. Public hospitals typically serve the most vulnerable populations, and those that face major challenges in accessing private health care services.

"Public hospitals may become an endangered species," said Dennis Andrulis, Ph.D., lead study author, formerly of SUNY Downstate Medical Center, and now with Drexel University School of Public Health. "Not only are public hospitals disappearing from inner cities across the country; they are disappearing from the suburbs as well."

The report funded by the Robert Wood Johnson Foundation shows that urban public hospitals provided less inpatient and emergency care in 2002 than in 1996, with for-profit hospitals now surpassing public hospitals in total admissions for the 100 largest cities. Yet, public hospitals continue to care for more seriously ill patients, as measured by the average length of a hospital stay.

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In this fifth installment of the series The Social and Health Landscape of Urban and Suburban America, the focus is on key factors of hospital use and availability. The data, provided by the American Hospital Association, were analyzed by ownership type (for-profit, non-profit and public) and by levels of poverty (low, medium and high). The review covers the volume of inpatient and outpatient care, including emergency department visits; number of beds, average length of stay (ALOS) and occupancy rate; three types of specialty care: level 1 and level 2 trauma centers, neonatal intensive care beds, and positron emission tomography (PET) scanners; and hospital revenues and margins.

Perhaps the most unexpected and potentially troubling finding was that high-poverty suburbs appear to be relatively underserved by hospitals, compared to low-poverty suburbs, which appear to have an abundance of hospital resources. Among the metropolitan areas of the 100 largest cities, high-poverty suburbs made up 44 percent of the total suburban population in 2000, but accounted for only 20 percent of total admissions, inpatient days, and outpatient and emergency visits in 2002. For the same years, low-poverty suburbs comprised only 26 percent of the total suburban population, yet had more than more than 40 percent of all suburban hospital admissions, outpatient visits and emergency department visits.

"While we all may read more about the impact of public hospital closures on inner cities, the fact is we are also seeing the potential for an impending access crisis in suburbs with high-poverty populations," said Andrulis. "These high-poverty suburbs exist disproportionately in California, Texas and other areas in the south."

The report finds that on average high poverty suburbs have five times the percentage of Latino residents as low-poverty suburbs (26.4 percent versus 5.3 percent) and twice the percentage of population that is foreign-born.

Prior surveys have documented these groups as having the highest uninsured rates in the country.