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Study: Hospital Closures Don’t Hurt Patient Outcomes

Closures more likely in areas with adequate hospital supply, authors say

Although hospital closures remain a major concern within the health care industry, they did not significantly affect hospitalizations or mortality rates in recent years, according to a new study published in Health Affairs and summarized by FierceHealthcare.

Researchers led by Karen E. Joynt, MD, of the Harvard Medical School analyzed the American Hospital Association's “landscape change” reports, which track changes in the national hospital census and their causes (such as mergers and acquisitions, openings, or closures) year-to-year, between 2005 and 2010 and used Medicare cost reports to confirm the data. Because the two sources tracked so closely, the researchers expanded the study period to include closures from 2003–2005 and 2010–2011.

Joynt and her colleagues identified 195 closures between 2003 and 2011 and found that closed facilities tended to be for-profit and were often located in the South and in urban areas. Compared with hospitals that remained open, they were less likely to be critical-access hospitals but were more likely to be “safety net” hospitals. Medicare beneficiaries in service areas with a closed hospital were, on average, 79.7 years old.

“The first thing we looked at was patient mortality,” Joynt told FierceHealthcare. She and her team found no significant change in population-level annual mortality from the year prior to a closure to the year after, and no discernible difference in population-level inpatient admissions or inpatient per-beneficiary costs.

“And then we looked at mortality for conditions for which you’d expect that travel times or timely access to care would be particularly important, and again, when we looked at those, we did not see any evidence that mortality rates were higher in communities where a hospital was closed,” she said.

Joynt noted that the study was limited by its restriction to Medicare beneficiaries, and reflected averages, meaning there could have been individual cases of poor outcomes because of hospital closures.

“I suspect that the reason we didn’t see [worsened outcomes] was because a lot of those closures happened in areas where there was adequate hospital supply, because a lot of them were urban and suburban areas, as opposed to isolated rural areas,” Joynt told FierceHealthcare. “I suspect travel differences would not have been vastly different after a closure.”

Indeed, Joynt said, the closures may have been to some patients’ benefit, as they would find themselves travelling slightly farther but visiting a hospital that was likely in better financial shape.

Sources: FierceHealthcare; May 4, 2015; and Health Affairs; May 2015.

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