By Kritee Gujral, Anirban Basu
National Bureau of Economic Research, August 2019
This paper examines the impact of California’s hospital closures occurring from 1995-2011 on adjusted inpatient mortality for time-sensitive conditions: sepsis, stroke, asthma/chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI). Using a difference- in-difference approach on California’s Office of Statewide Health Planning and Development (OSHPD) data, the impact of hospital closures on inpatient mortality is estimated. Outcomes of admissions in hospital service areas (HSAs) with and without closure(s) are compared before and after the closure year. The paper aims to fill gaps in prior work by using a reconciled list of California’s hospital closures and by studying differential impacts of rural and urban hospital closures. To our best knowledge, this is also the first paper explicitly studying patient outcomes of California’s rural closures. Results suggest that when treatment groups are not differentiated by hospital rurality, closures appear to have no measurable impact. However, estimating differential impacts of rural and urban closures shows that rural closures increase inpatient mortality by 0.46% points (an increase of 5.9%), whereas urban closures have no impact. Results differ across diagnostic conditions; the general effect of closures is to increase mortality for stroke patients by 3.1% and for AMI patients by 4.5%, and decrease mortality for asthma/COPD patients by 8.8%.
Assuring continuing access to health care in rural America
By Paul Morton Ganeles
tucson.com, Aug 24, 2019
In his Aug. 22 op-ed, Dr. TK Kelly, an emergency medical MD, appropriately stressed the problems rural residents encounter when requiring emergency medical services. During my career, I served for some 28 years as a CFO in three major metropolitan teaching hospitals; a Medicare provider appeals judge and agency chairman appointed by the secretary of health and human services; and the founding director of finance for the Hospital Association of New York State (HANYS).
In that HANYS job, I periodically conferred with health-care financial executives from most other states. They would kid me when the topic of rural hospital concerns arose that I didn’t have to listen. I reminded them that I represented more than 100 rural hospitals — not just Big Apple hospitals — and that I had vital concerns about those isolated but essential health facilities.
While the headline for the Kelly op-ed related to a funding crisis for air medical services, his essay also cited the long-standing financial plight of small rural hospitals across America which often provide lifesaving emergency medical and maternal care for farmers and ranchers and their families and employees. Those individuals often lack adequate health insurance to pay for their care and/or air transportation in dire emergencies. Even if they have insurance, those programs rarely reimburse the costs of their service and place financial burdens on hospitals and air medical providers that threaten their survival.
Kelly observed that, in the past nine years, 102 rural hospitals across America closed, and three of those were in Arizona. Kelly affirmed, “access to health care in rural America is disappearing.” My experience with HANYS in the early 1970s and since then validates Kelly’s observation and proves that the plight of rural hospitals has plagued America for more than 40 years.
Congress long ago recognized that rural health-care access and financial survival problem years ago as it enacted laws to tweak Medicare rural hospital reimbursement. Congressional actions consistently have proven to be inadequate to solve the problem because of the arcane black-box algorithms that underlie Medicare reimbursement rules.
During the experiences of my career in health care, which emphasized the costs of health care and how to cover them while providing those who need access to quality health services and with a variety of health-care funding mechanisms, I long ago concluded that America would not be able to effectively cope with the need to provide adequate access to quality care for all Americans until it scrapped its fragmented insurance and medical financing methods and adopted a single-payer insurance system (like a version of Medicare for All). The cost of covering everybody would be met by substantially reducing administrative expenses (the arcane coding and billing systems are virtually a total waste), by eliminating health-care and insurance advertising expenses, by eliminating profits, and by eliminating the obscenely exorbitant levels of compensation paid to health-care and insurance executives.
Enough studies have proven that America will be able to meet its health-care needs under a single-payer program while reducing total costs (premiums, copayments, deductibles, etc.) to every American.
That thesis also has been proven by the actual experiences of the world’s leading nations, which incur lower costs and better health-care outcomes than the U.S. to provide access to adequate health-care services not only to every resident but also, in many cases, to every visitor.
By Don McCanne, M.D.
Closing rural hospitals increases mortality, by 5.9% according to this study. That’s not good.
In his op-ed, Paul Morton Ganeles – an experienced executive who understands rural hospitals – states, “I long ago concluded that America would not be able to effectively cope with the need to provide adequate access to quality care for all Americans until it scrapped its fragmented insurance and medical financing methods and adopted a single-payer insurance system (like a version of Medicare for All).”
He also notes, “Congressional actions consistently have proven to be inadequate to solve the problem because of the arcane black-box algorithms that underlie Medicare reimbursement rules.” Of course, that is a major reason why we need an improved Medicare for All.
We keep providing evidence of the superiority of the single payer model of Medicare for All – a method of health care financing that is more effective, more efficient and more equitable than all others – truly affordable for each of us. So why are we even discussing lesser, fragmented and dysfunctional models such as ACA and employer-sponsored plans? They tell us that it is because people should have their choice of these less effective, less efficient, less comprehensive, and less equitable plans, if they want them. But who would really want them if they truly understood the differences?
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