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Redfairen

(1,276 posts)
Fri Apr 26, 2013, 12:47 PM Apr 2013

The Decline of Emergency Care: ER's & Trauma Centers Closing En Masse

...across the country, more and more trauma centers and emergency departments are closing. And they're closing in communities that need them the most.

It isn't that there are fewer emergencies. According to the American Hospital Association, from 1991 to 2010, emergency department visits soared from 88.5 million to 127.2 million. That's an increase of nearly 44 percent. But during this same period, emergency departments closed at a rate of almost 11 percent. We see something similar with trauma centers. Between 1990 and 2005, 339 trauma centers shut their doors. If we know these services work for terror attacks as well as ordinary traumas, such as car crashes, then why are they closing?

Over the past four years, Renee Hsia, an emergency medicine physician, and Yu-Chu Shen, an economist, have written about closing emergency rooms and trauma centers. They have been interested in two primary questions. First, they have tried to figure out what makes a trauma center more likely to close. It turns out a major reason isn't poor performance. It's cost. Trauma centers are expensive to run; they depend on public funding (such as Medicare reimbursements) and face financial pressures from HMOs to specialize in more profitable services.

Hsia and Shen have also asked how these closures impact vulnerable populations. Part of the reason that trauma centers are unprofitable is that they treat many uninsured, or self-pay, patients, and patients on Medicaid. According to the most recent National Trauma Data Bank report, 27 percent of trauma patients are self-pay or Medicaid patients. When trauma centers close, does it hurt these patients the most?

The answer is yes. To get there, Hsia and Shen studied how driving time to trauma centers changed over a six year period for 99 percent of the US population, or 283 million people. Here's how they did it. First, they pulled data on trauma centers from the American Hospital Association annual surveys between 2001 and 2007. Then, they linked this data with demographic data from the 2000 Census. To understand county-level insurance information, they drew from the federal government's 2005 Area Resource Files. Compared with travel times six years earlier, Hsia and Shen found that one out of every four people had to travel longer to get to a trauma center. And nearly 16 million had to travel at least thirty minutes more.

http://www.theatlantic.com/health/archive/2013/04/the-decline-of-emergency-care/275306/

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The Decline of Emergency Care: ER's & Trauma Centers Closing En Masse (Original Post) Redfairen Apr 2013 OP
instead of growing kinder and more caring to one another, barbtries Apr 2013 #1
This has been going on for decades... Triana Apr 2013 #2
ER has always lost money newfie11 Apr 2013 #3
They are funded by cost shifting from profitable areas of the hospital. undeterred Apr 2013 #4
Our health care system is failing. nt bemildred Apr 2013 #5
+1 area51 Apr 2013 #6
I'd put that in the past tense. nt raccoon Apr 2013 #7
OK. bemildred Apr 2013 #9
The inevitable result of a demented for-profit "health care" system. marmar Apr 2013 #8

newfie11

(8,159 posts)
3. ER has always lost money
Fri Apr 26, 2013, 02:06 PM
Apr 2013

Having worked at a level 1 trama center I would hate to have a major life threatening accident and be taken to an ordinary ER.

I hope this isn't a coming trend but like everything else if money isn't there it's all over.

undeterred

(34,658 posts)
4. They are funded by cost shifting from profitable areas of the hospital.
Fri Apr 26, 2013, 02:38 PM
Apr 2013

And they are caring for the uninsured in this country, of which there are too damn many.

bemildred

(90,061 posts)
9. OK.
Sat Apr 27, 2013, 01:00 PM
Apr 2013

I started minimizing my exposure to "health care" some 15 years ago, so I've been there for a while now. When you get old they tend to look at you like fresh meat anyway, a future revenue stream.

Nevertheless, there are times when you have to get professional care, and modern medicine is quite good at some things.

The real problerm is that you cannot rely on the advice you are given or the safety of the treatments offered, treatment tends to be so time-constained (gotta pay off those loans) that you tend to get generic treatments or they "try things" to see what works, etc. so if you are not a generic person, you're out of luck.

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