Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003-11.
The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was there a significant difference in the change in all-cause mortality rates following hospitalization (9.1 percent to 8.2 percent in HSAs with a closure versus 9.0 percent to 8.4 percent in those without a closure). HSAs with a closure had a drop in readmission rates compared to controls (19.4 percent to 18.2 percent versus 18.8 percent to 18.3 percent). Overall, we found no evidence that hospital closures were associated with worse outcomes for patients living in those communities. These findings may offer reassurance to policy makers and clinical leaders concerned about the potential acceleration of hospital closures as a result of health care reform.
Karen E. Joynt (kjoynt@partners.org) is an assistant professor in the Division of Cardiovascular Medicine, Harvard Medical School and Brigham and Women's Hospital, and an instructor at the Harvard T.H. Chan School of Public Health in the Department of Health Policy and Management, both in Boston, Massachusetts. She is currently serving as a senior adviser to the deputy assistant secretary for health policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C.
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Paula Chatterjee is a resident in medicine at Brigham and Women's Hospital.
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E. John Orav is an associate professor of medicine (biostatistics) at Harvard Medical School and Brigham and Women's Hospital and an associate professor of biostatistics at the Harvard T.H. Chan School of Public Health.
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Ashish K. Jha is the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health.
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D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D005377:Financial Management, Hospital / Q000706:statistics & numerical data; D006271:Health Facility Closure / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
Access To Care; Health Reform; Hospitals; Quality Of Care; Rural Health Care