title: Residential segregation and the survival of U.S. urban public hospitals.
abstract: Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.
authors.affiliation: 1University of California, San Francisco, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ko
authors.forename: Jack
authors.initials: J
authors.lastname: Needleman
authors.forename: Kathryn Pitkin
authors.initials: KP
authors.lastname: Derose
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Laugesen
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D006271:Health Facility Closure / Q000706:statistics & numerical data; D006291:Health Policy; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D063505:Racism / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
keywords: hospital closures and conversions; public hospitals; residential segregation; safety net