Public hospitals decline swiftly

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Public hospitals are vanishing at a much faster rate than U.S. hospitals overall, according to a report released today.

While the number of U.S. hospitals has decreased over the past decade, public hospitals in the nation's 100 largest cities and nearby suburbs recorded the sharpest drop, said the report by the State University of New York's Downstate Medical Center, a Brooklyn municipal hospital and medical college.

The number of public hospitals declined by 27 percent in major suburbs, from 134 in 1996 to 98 in 2002, the report said.

The number of public hospitals declined by 16 percent in major cities, from 83 to 70, said the report, the fifth in a series the center has done on hospitals in large cities and suburbs.

The report did not track the reasons why public hospitals closed, said lead author Dennis Andrulis.

"But we did get the general sense that they were either shutting down, facing a major downsizing in operations, or being consolidated," said Mr. Andrulis, an associate dean for research at Drexel University in Philadelphia.

Mr. Andrulis' report was funded by the Robert Wood Johnson Foundation, a Princeton, N.J., philanthropic organization. Its findings were based on data from federal agencies and surveys done by the American Hospital Association.

Public hospitals, which are funded by local governments, are often considered safety nets for uninsured patients who have little access to medical care.

An increase in the number of uninsured Americans is straining many public hospitals to the point of bankruptcy, said Mark Wietecha, chairman of Kurt Salmon Associates Inc., an Atlanta health care consulting firm.

"The growth in uninsured people is far quicker than the money available for the public hospitals to care for them," he said.

About 45 million Americans were uninsured in 2003, according to the most recent data from the U.S. Census Bureau. That number is expected to jump to 48 million by the end of the year.

Fewer public hospitals ultimately could drive up the cost of U.S. health care, because poor patients will continue to seek care at emergency rooms at other hospitals, Mr. Andrulis said.

"In suburban areas there is a major increase of ER visits by poor patients because of this," he said. Low-income patients made an estimated 10.5 million visits to 839 suburban hospitals surveyed in 2002, the report said.

Washington-area hospitals, such as Greater Southeast Community Hospital and Prince George's Hospital Center, have reported treating a higher number of indigent residents since the city closed its public hospital, D.C. General, in June 2001.