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Saturday, September 3, 2016

Hospital Closures In the United States and the Impact on the Availability of Health Care Services

Hospital Closures throughout the United States-Adversely Impacting Small Towns

Today, I opened the paper to learn that the Catholic order which purchased the community hospital in my city of 39,056 souls is going to close the hospital.[1] The hospital was built with public funds and run as a nonprofit, but gradually began to branch out into more lucrative service areas. My community has the largest concentrated population of low-income (Medicaid eligible households) in the county, which was by design, thanks to government sanctioned higher-density housing to accommodate the burgeoning ranks of WWII workers. Consequently, the availability of low-income housing and access to health care, with minimal transit costs, made this a live-able community for veterans, retirees, and single families. In recent years, the area has enjoyed a resurgence in popularity with young families, moving over from the mainland, because of the good schools, clean air, and affordable homes. However, young families may give pause to relocate to a city without a hospital. When my son was hit by a car I was awfully glad to have a short commute to the local hospital.
 Rallying Cry
When HMC was purchased by CHI Franciscan, it was put on notice that the Catholic hospital group intended to close the Bremerton hospital. The nurse’s union actually ran a protest, but now there doesn’t even appear to be a whimper. The current hospital in town has 253 beds, which means it is not a small facility.  The hospital cites inadequate parking and requisite system upgrades as the reasons it wants to leave the present facility. Why can’t the city arrange a bond issue to help pay for facility upgrades along with the Franciscan Order? Because the hospital was purchased from our locally funded  community hospital and absorbed by the much larger private nonprofit hospital group, the tether of control has been snipped. This issue is now up to the Washington State Hospital Commission, under the State Department of Health, to approve, deny, or stipulate changes to CHI.
No Money No Mission
Having worked for the network finance office of Ascension Health, the largest Catholic hospital chain in the U.S. with facilities in 24 states, I can assure you they do make a healthy profit, part of which winds its way to the Vatican. To understand the economic reasons for the Franciscan Hospital relocation to a wealthier suburb north of town, versus upgrading facilities in our community of 39,056 people, I have prepared this chart which shows income and Medicaid levels, as indicated through public school lunch subsidies for each community.

Percentage on Subsidized School Lunches
58.4% of school enrollment
24% of school enrollment
38.2% of enrollment
Average Household Income
Enrollment in school lunch programs is based on the high school for each location, as it represents the most consolidated public school student population for that community.[2]
Income information comes from public web sites for each city or in the case of Silverdale, which is an unincorporated area, from The people of Silverdale have consistently voted against incorporating and this is the area which Franciscan wants to expand their facilities.

Impact of Medicaid Expansion
Washington State was one of the states to adopt the Affordable Care Act’s expanded definition for Medicaid eligibility, allowing enrollment for those with incomes up to 133% of the Federal Poverty Level. This has resulted in a massive enrollment increase in state Medicaid plans, with approximately one third of the state population now enrolled on Medicaid. This means that one third of that population are of low-income status.  I suspect this phenomenon is true or even more pronounced throughout much of the country, but those states which did not increase their Medicaid eligibility do not have to report or be financially accountable for this expanded demographic. Essentially, the Medicaid population includes a lot of single-parent families, disabled persons, students, and those who are under-employed, which means they are only able to obtain part-time or inconsistent employment. The insurance companies (Aetna and United Healthcare) participating in the insurance exchanges are currently decrying the expense for medical claims for this very population, whom you can imagine had no health care for years, and probably more than a few ailments. This phenomenon is referred to as deferred health care, as in when-you-can't-afford-to-pay-for-it-you-don't-get-treatment.
National Perspective
Could your hospital be slated for closure? Currently there are 77 hospitals slated for closure in the U.S. up from 50 just two years ago. Texas has had 10 hospital closures, more than any other state and 175 employees were laid off in Dallas, following closure of Forest Park Medical Center.[3] Review this list by Becker Hospital Review, from August of 2016 to see how your state fares.[4] 
Lack of access to health care is cause by three things, lack of facilities, available trained staff, and inadequate financial reimbursements for some services. This article illustrates how the frayed safety net of health care services adversely impacts the vulnerable through facilities closure, for in the United States, healthcare is all about the money trail.

And this is the healthpolicymaven signing off encouraging you to be fully informed before you consent to any health care procedure, regulation, or contract. The "healthpolicymaven" is trademark of Praevalere Inc. and Roberta E. Winter, in continuous publication since 2007. Winter is the author of a guidebook to the U.S. healthcare system, which was published by Rowman and Littlefield in 2013.

[1] Mark Briant, CHI Franciscan Health Planning to Close Harrison Medical Center, Bremerton Patriot, September 2, 2016, vol. 9 no. 24
[2] Office of the Superintendent of Public Instruction, Washington State
[3] Ayla Ellison, Texas Hospital Closes, Lays off 175 Before New Owner’s Take Over, Beckers Hospital, May 26, 2016
[4]Ayla Ellison, A State By State Breakdown of 76 Rural Hospital Closures, Beckers Hospital, August 23, 2016


Apu Mridha said...

Thanks for sharing such an amazing and informative post. Really enjoyed reading it. :)


healthpolicymaven said...

Thanks so much for your post, please continue to read my column, which has been in continuous publication since December 2007.

Herry Johnson said...
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