The Decline of Emergency Care: ER's & Trauma Centers Closing En Masse [View all]

[Redfairen]

...across the country, more and more trauma centers and emergency departments are closing. And they're closing in communities that need them the most.

It isn't that there are fewer emergencies. According to the American Hospital Association, from 1991 to 2010, emergency department visits soared from 88.5 million to 127.2 million. That's an increase of nearly 44 percent. But during this same period, emergency departments closed at a rate of almost 11 percent. We see something similar with trauma centers. Between 1990 and 2005, 339 trauma centers shut their doors. If we know these services work for terror attacks as well as ordinary traumas, such as car crashes, then why are they closing?

Over the past four years, Renee Hsia, an emergency medicine physician, and Yu-Chu Shen, an economist, have written about closing emergency rooms and trauma centers. They have been interested in two primary questions. First, they have tried to figure out what makes a trauma center more likely to close. It turns out a major reason isn't poor performance. It's cost. Trauma centers are expensive to run; they depend on public funding (such as Medicare reimbursements) and face financial pressures from HMOs to specialize in more profitable services.

Hsia and Shen have also asked how these closures impact vulnerable populations. Part of the reason that trauma centers are unprofitable is that they treat many uninsured, or self-pay, patients, and patients on Medicaid. According to the most recent National Trauma Data Bank report, 27 percent of trauma patients are self-pay or Medicaid patients. When trauma centers close, does it hurt these patients the most?

The answer is yes. To get there, Hsia and Shen studied how driving time to trauma centers changed over a six year period for 99 percent of the US population, or 283 million people. Here's how they did it. First, they pulled data on trauma centers from the American Hospital Association annual surveys between 2001 and 2007. Then, they linked this data with demographic data from the 2000 Census. To understand county-level insurance information, they drew from the federal government's 2005 Area Resource Files. Compared with travel times six years earlier, Hsia and Shen found that one out of every four people had to travel longer to get to a trauma center. And nearly 16 million had to travel at least thirty minutes more.

http://www.theatlantic.com/health/archive/2013/04/the-decline-of-emergency-care/275306/