title: The effects of safety net hospital closures and conversions on patient travel distance to hospital services.
abstract: OBJECTIVE
  To examine the effects of safety net hospital (SNH) closure and for-profit conversion on uninsured, Medicaid, and racial/ethnic minorities. DATA SOURCES/EXTRACTION METHODS: Hospital discharge data for selected states merged with other sources.
  
  
  METHODS
  We examined travel distance for patients treated in urban hospitals for five diagnosis categories: ambulatory care sensitive conditions, referral sensitive conditions, marker conditions, births, and mental health and substance abuse. We assess how travel was affected for patients after SNH events. Our multivariate models controlled for patient, hospital, health system, and neighborhood characteristics.
  
  
  RESULTS
  Our results suggested that certain groups of uninsured and Medicaid patients experienced greater disruption in patterns of care, especially Hispanic uninsured and Medicaid women hospitalized for births. In addition, relative to privately insured individuals in SNH event communities, greater travel for mental health and substance abuse care was present for the uninsured.
  
  
  CONCLUSIONS
  Closure or for-profit conversions of SNHs appear to have detrimental access effects on particular subgroups of disadvantaged populations, although our results are somewhat inconclusive due to potential power issues. Policy makers may need to pay special attention to these patient subgroups and also to easing transportation barriers when dealing with disruptions resulting from reductions in SNH resources.
authors.affiliation: Department of Health Administration, Virginia Commonwealth University, Richmond, PO Box 980203, VA 23298-0203, USA. gbazzoli@vcu.edu
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Bazzoli
authors.forename: Woolton
authors.initials: W
authors.lastname: Lee
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Hsieh
authors.forename: Lee Rivers
authors.initials: LR
authors.lastname: Mobley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006271:Health Facility Closure / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States
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