Public hospitals seen slipping away, changing into other entities

The trend raises concerns about the safety net for poor and uninsured patients, but researchers point out that some transformed facilities still play a role.

By Katherine Vogt, AMNews staff. Sept. 12, 2005.

A new study using American Hospital Assn. data has found that the number of public hospitals is falling at a faster rate than other facilities.

Between 1996 and 2002, the number of public hospitals decreased by 16% in the nation's largest 100 cities and 27% in those cities' suburbs. Those 100 cities had 645 facilities in 2002, down from 730 in 1996, while in the suburbs the drop was to 98 from 134. Meanwhile, the number of for-profit hospitals fell by 11% in cities and 11% in suburbs. Nonprofit hospitals lost 11% in cities and 2% in the suburbs.

The numbers were released Aug. 17 in a report by the State University of New York Downstate Medical Center.

"The classic public hospital is declining," said Dennis Andrulis, PhD, lead author of the study and director of the Center for Health Equality at the Drexel University School of Public Health in Philadelphia.

However, the hospitals, in most cases, weren't shutting down completely. Dr. Andrulis said the data showed that while some public hospitals closed, others were simply transformed into different kinds of entities.

"Some local governments are taking action to position what were previously public hospitals -- position them more positively -- to survive in a more competitive market-driven environment while still maintaining their safety net," he said, citing Boston Medical Center as an example.

The National Assn. of Public Hospitals and Health Systems has record of only two public hospitals closing in approximately the last 10 years, said Skip Moskey, an assistant vice president. However, the organization has seen a trend of ownership structures changing in recent years.