Market factors affect closures of emergency departments nationwide

Despite a rise in the number of emergency room patients, the number of hospital-based emergency departments in the U.S. is in decline, according to a study led by Renee Hsia, MD, MSc, an emergency physician at San Francisco General Hospital, and featured in the May 18 issue of the Journal of the American Medical Association.

During the last two decades, nearly one third of urban and suburban emergency rooms have closed, with little known about related , community, and market factors. In particular, federal law requiring for those in need, regardless of ability to pay, may make emergency departments especially vulnerable to market forces.

“One of the reasons we did this study was to examine the overall trends in the supply of ERs,” said Hsia, an assistant professor in the Department of Emergency Medicine, UCSF School of Medicine. “Now we have good data to show that we have fewer ERs with increased demand, which inevitably means more crowding. While we do our best in the ER to triage and spend the time on the most critical patients, there is a point when demands outpace the availability of resources.”

The study concludes that from 1990 to 2009, the number of hospital emergency rooms in non-rural areas declined by 27 percent, from 2,446 to 1,779. An analysis of 2,814 urban acute-care hospitals found that hospitals in more competitive markets, for-profit hospitals, hospitals with a low profit margin, safety-net hospitals and those serving a higher share of populations in poverty have a significantly higher risk of closing their emergency departments.

Hsia's research focuses on barriers to access to emergency care for vulnerable populations, as well as reimbursement and financing within health care systems. She is also a recipient of the KL2 Scholar career development award, supported by the Clinical and Translational Science Institute (CTSI) at UCSF.

Read the full text of the article in JAMA here Factors Associated with Closures of Emergency Departments in the United States.

add to favorites email to friend print save as pdf

Related Stories

Report says U.S. ERs in crisis

Jun 15, 2006

The Institute of Medicine in Washington says the U.S. emergency care system is fragmented and severely compromised in its ability to handle disasters.

Recommended for you

Exploring 3-D printing to make organs for transplants

Jul 30, 2014

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

Jul 30, 2014

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments