Hospital Closures: A Working Paper Examines Impact on Patient Care
Diving Deeper on the Nuances of Healthcare Disruptions
Hospital closures significantly reshape the healthcare landscape, influencing patient outcomes, care quality, and market dynamics. A new working paper delves into the multifaceted effects of these closures over two decades (1994-2013), challenging prevailing notions and offering critical insights. The NBER Working Paper (Are Hospital Quality Indicators Causal? by Amitabh Chandra, Maurice Dalton & Douglas O. Staiger) exploration provides a clearer perspective on hospital shutdowns, informing future healthcare decisions and policies.
By the numbers:
Over 20 years (1994-2013), an average of 0.22% of patients attended a hospital that would close the following year. Cumulatively, this implies that around 4.4% of all patients were impacted by a closure.
For those affected, hospital closure meant a decrease in mortality by 0.184%. To simplify, for every 1,000 patients attending a closing hospital, there would be 1.84 fewer deaths.
This average mortality change needed to be more consistent. In areas served by low-quality hospitals, mortality decreased by 1.46 percentage points. Conversely, in regions with high-quality closing hospitals, mortality increased by 1.03 percentage points.
Black patients were more likely to be affected by hospital closures than whites, with a rate of 0.32% compared to 0.22%. Yet, the overall impacts, whether benefits or harm, were similar to the broader population.
Hospital closures also slightly reduced readmission rates and increased resource use by about 1%.
The big picture:
The quality of the closing hospital is pivotal in assessing its closure's effects. Contrary to popular belief, the paper found most hospital closures reduce affected patients' mortality since the neighboring hospitals usually provide higher-quality care. This counters the assumption that closures harm patients due to treatment delays.
The findings:
Hospital quality metrics can help predict potential hospital closures' impact on patient outcomes. In many instances, closures enhance patient results, especially when distance isn't a significant factor.
The direct measures of quality (like mortality) can be more effective than process measures in the medical realm, proving useful for policy development.
Furthermore, the paper sheds light on the role of market forces in healthcare. Patients gravitate towards hospitals with lower mortality rates, reflecting their genuine knowledge of risk-adjusted quality. There's a need to explore how the market spreads information about quality, mainly since racial disparities in care result primarily from minorities being treated at lower-quality hospitals.
A look forward:
The ease of computing causal hospital quality indicators makes it feasible to design narrow networks and employ cost-sharing to dissuade the usage of less effective providers. It's pivotal to note that these measures are valid for the scope of reallocations caused by closures.
What they are saying:
Hospital closures don't inherently harm patients; closing high-quality hospitals does. Quality measures can help optimize patient care, providing a roadmap for future healthcare policies and strategies.