Decrease in Number of Hospital Emergency Departments

Location in a competitive market, safety-net status, low profit margin associated with closure

TUESDAY, May 17 (HealthDay News) -- Between 1990 and 2009, there was a substantial decrease in the number of hospital emergency departments (EDs) in nonrural areas, according to a study published in the May 18 issue of the Journal of the American Medical Association.

Renee Y. Hsia, M.D., from the University of California in San Francisco, and colleagues investigated the market, community, and hospital factors correlated with the closure of EDs. Information about EDs was acquired from the annual surveys of the American Hospital Association (1990 to 2009). Hospital characteristics (including safety net, teaching status, system membership, and ED size), community population demographics (race, poverty, insurance, elderly), and market factors (including profit margin, competition, and presence of other EDs) were evaluated.

The investigators found that the number of EDs in nonrural areas decreased from 2,446 in 1990 to 1,779 in 2009, with 1,041 EDs closing down and 374 opening. In an analysis of 2,814 urban hospitals between 1990 and 2007, for-profit hospitals and those with a low profit margin were more likely to close (hazard ratio [HR] in a bivariate model, 1.8). An increased risk of closure was correlated with being in a more competitive market (HR, 1.9), being a safety-net hospital (HR, 1.4), and serving a higher share of populations in poverty (HR, 1.4).

"This study demonstrated that, from 1990 to 2009, the number of hospital EDs in nonrural areas declined by 27 percent, with for-profit ownership, location in a competitive market, safety-net status, and low profit margin associated with increased risk of ED closure," the authors write.

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