MLK

The decrease in public hospitals in the U.S. has resulted in diminished access to healthcare for vulnerable and low income populations and has overcrowded the remaining healthcare agencies that still exist. The U.S. already suffers from an under supply of physicians to care and treat the whole population. The decrease in public hospitals minimizes options for Medic-Aid, Medi-Care, and SCHIP patients to find care. Public hospitals serve the communities by providing primary medical care, specialty care such as OB/GYN, and pediatrics….without close, accessible public hospitals, many families will have to navigate further or find alternative modes of transportation to reach further healthcare hospitals or community clinics. I have spoken to one of the nurses at MCA where I work and she was a former nurse at MKL before they closed down. Parts of MLK are still open such as their internal medicine department. However, the OB/GYN and pediatrics units were shut down. In an attempt to save the maternal and peds units, the nursing staff compiled documents reporting the number of women and children they served and for what purposes. Their protest to save MLK were based on the grounds that the hospital was a vital resource for women and their families and by shutting down the hospital, these women would be left underserved. Unfortunately, they were defeated and MLK shut down and many families were left to seek healthcare elsewhere. They were forced to find healthcare outside of their living and working vicinity because of the scarcity of public hospitals in LA. Many may have even stopped seeking healthcare due to transportation limits.

Financial and.....

I worked at LAC+USC at the time when MLK was going through its initial closure. I'm not exactly sure the reasons for it's closure were purely financial. This leads me to question the reason why these other facilities have been closed. I did notice an added stress when this facility closed as more people were forced to seek other public instiutions for medical care. I wonder if this will cause a snowball effect with quality of medical care declining at other local public health faciliites due to the added stress of the additional population? Future plans need to accomodate for a growing population, something that was not addressed in the newly constructed LAC+USC.

Public Hospitals on the decline......

We definitely need to do something about the closing of Public Hospitals in a time when they are required most. Public hospitals serve the underserved and individuals who cannot afford healthcare. If these were to close down, where would these individuals go?
Especially in the current times of economic reccession more people are losing their jobs and the pool of uninsured is increasing. These individuals then depend on the Public hospitals to take care of their health care needs. There has been an increased burden on these hospitals to provide care. This overstretches the system and has pushed many of these hospitals into bankruptcy. The very fact that these hospitals are overworked is a witness to the fact that they are required. And the solution to that is not closing them down for financial reasons but rather the state stepping in to finance them. This will not only take care of the underserved , many of whom come for acute problems rather than chronic but also keep our uninsured with no health care pool from rising.

For some reason I can't reply directly on Harut's blog entry like I originally wanted to, so I'll post a new blog as a response to his comments:

I definitely agree with Harut that there is absolutely no time to spare and that this issue cannot take a backseat, especially with the current economic crisis that we are faced with in America. Even fewer families are able to afford healthcare now than before the collapse of the economy. I'm glad that we have a president who now sees this and has made healthcare reform a priority. There are a lot of things that President Obama said last night in his State of the Nation and I got the following from a CNN article and thought it was really interesting:

"Obama's prescription for health-care reform included making "the largest investment ever" in preventive care, rooting out Medicare fraud and investing in electronic health records and new technology in an effort to reduce errors, bring down costs, ensure privacy and save lives."

I think it is interesting that he puts preventive care so high on his to-do list, as this is a topic that we debated heavily just a few weeks ago. The link for the rest of the CNN article is:
http://www.cnn.com/2009/POLITICS/02/24/obama.health.care/index.html

Another Reason For Healthcare Reform...

It's quite simple, really. The number of uninsured people in the United States is growing in an extremely rapid pace. Simultaneously, the amount of public dollars available to keep these public hospitals going is on a decline like no other. These two factors don't match up favorably, and will lead to an unhealthier and more susceptible America. The first step - before restructuring and extra funding of public Hospitals - is getting GOOD health care reform legislation passed in Congress and signed by the President. This is an absolute must, and can not wait another year. Regardless of public perception of the current economic crisis (and its unyielding coverage by the media), health care lies upon us as a "bubble" just as large, ready to burst. Our public Hospitals are the foundations that keep health care in this country alive, and must stand strong. Allowing Universal Health Care will lead to public hospitals regaining their legs, and standing on their own two feet. The amount of families that loose their homes, declare bankruptcy, and essentially see their lives in "ruins" due to health care costs is tremendous. We can do this! We already spend the money needed - let's just get it right this time!

Public and Private Hospital Partnership

The increasing competiveness of the health care system has proven to threaten the survival of many public hospitals. Many have been forced to close down due to their inability to reduce their costs below the national average as well as inefficient administrative procedures. The closure of hospitals whether it is in rural or urban areas may have the potential to negatively impact the lives and health care of the more economically disadvantaged but at the same time it may be productive for the system as a whole. When public hospitals shutdown, the individuals that would normally use their services are faced to seek aid elsewhere (i.e. private hospitals) and many times the prices are generally higher at private hospitals than at public hospitals. Because the uninsured and underinsured are more likely to have limited education, and be economically disadvantaged they are more sensitive to these higher prices. However, as public hospitals are forced to shut down there seems to be the potential for public and private partnerships within the hospital systems. Many communities that have turned to this mixed model of ownership and financing have been successful in achieving their goals of maintaining the service mission of the public hospital while also attracting a mix of patients that would enhance financial stability. This has the potential to be a great fit for the system as it achieves efficiency, flexibility, integration and planning, proximity to the community in need, and the ability to support medical education needs. Co-operating and integrating together, putting the two resources together, you've got the ability to provide a better service overall to the community, by trying to avoid duplication, competition and sharing costs, rather than duplicating costs.

Are we sure it's money?

I was raised in Watts and born in ther MLK Hospital. I still don't understand why it was closed. It served the largest number of "underserved" individuals. Is it really a money issue or are there more social politics around inequalities and racial/class disparities revolving around it? ... I have yet to understand this issue....

No Public Hospitals = Unhealthy America

The main difference between public and private hospitals is that the first is funded by the government and the latter is funded by either a single person or group. Private hospitals tend to offer better facilities and are, therefore, more expensive. Because of this, the uninsured and the poor usually go to public hospitals since they can't really afford private hospitals. The emergency departments of these hospitals are becoming way too overcrowded because the uninsured and poor know this is the cheapest option for them. People are coming to the ER for reasons they definitely do not classify as an emergency. Today while I was volunteering in the ER, probably only 1 out of every 15 patients were actually considered emergencies. The rest of the patients were just coming in for back pain, coughs, stomach aches, etc. This means that if these public hospitals keep closing, these emergency department patients will most likely not get the care they need because it's too expensive for them. This will cause an increase in obesity, heart disease, diabetes, and other health care problems that have already been on a rise. Unless there's another way to help out these poor and uninsured people, the health of the nation will just continue to decline.

keeping hospitals open...

The decline of public hospitals has severely affected the vulnerable populations. For populations like the elderly, economically disadvantaged, uninsured, and undocumented, public hospitals are their primary and even their only source of health care. Public hospitals, which are funded by local governments, are often considered safety nets for uninsured patients who have little access to medical care. However, because public hospitals are often treated like the ultimate safety nets (overused services w/o adequate compensation), many of them can no longer afford to keep their doors open. Caring for vulnerable populations puts a burden and a financial strain on hospitals that are barely making ends meet as it is. MLK is an example of these financial realities and its closure is extremely significant not only because it is located in an urban area, but because its in a part of LA that is already underserved. This has huge implications for our health care system as a whole because MLK is just one of the many hospitals that have closed in the declining trend. The decline of hospitals decreases health care access in a way that affects everyone. A decrease in access, in turn, means a decrease in quality and appropriate care and an increase in costs. And still hospitals that manage to keep their doors open, will experience overcrowding and longer wait times for their patients. The decline of public hospitals is happening rapidly and is affecting urban and rural areas equally. We need to find a way to keep hospitals open because the decline lowers access to quality/affordable care and ultimately results in an unhealthy and underserved population.

fewer public hospitals = less healthy population

The first thing that comes to mind, is the fact that the closing of hospitals will cause an overcrowding in those hospitals that remain. Not only will this discourage people from getting medical attention, as people will try to avoid the inconveniences associated with the overcrowding, but the quality of health care will decline. In addition, it will be more difficult for the poor and uninsured to obtain health care, as they may not be able to afford the private hospital costs. And, I would expect that as public hospitals become fewer, the cost of health care may increase since competition will thin out.

All of these barriers to health care would undoubtedly have a negative impact on the population's health. In general, these changes would lead to fewer people getting the medical care they need. Furthermore, The poor population, which is generally less healthy, would perhaps be the most affected by the closing of public hospitals. Thus, the health of the population would decline.

Public hospital closures indicate a failing system

Many public hospitals are being forced to close because the cost of treating their underserved community is not adequately covered by their revenues. This causes the remaining public hospitals to be further burdened and the underserved  to be even more underserved. This trend of public hospital closures is  indicative of a failing system. Although the notion of universal healthcare may seem like a radical notion, in many ways we are already providing it... just very inefficiently. There are many groups we have deemed eligible for government provided healthcare and for the remaining we have county hospitals. 

The more public hospitals we lose the more burden is placed on county hospitals, which by government decree cannot turn away their underserved. As the underserved community grows we are forced to open more institutions that specifically cater to them usually using government funds or grants. This is further burdening the system, especially due to the inefficiency of many different small clinics rather than the existence of one well funded hospital.  The transition towards universal healthcare is upon us. 

Public Hospitals on Decline

The number of individuals in the US without health insurance is already ridiculously high. And many of these people rely on the public hospitals emergency rooms for there health care needs. Most hospitals are in low SES communities and provide access to health care for these low income families. Once again with the closing of the public hospitals we get a glimpse at the true character of our health care system. It is really disappointing that the health care system seems to be more interested in making money than in helping people. If public hospitals are being replaced by private hospitals than the uninsured will have less option of where to go for health care, putting them at a greater disadvantage than they already are.

I think one of the biggest problems with public hospitals closing is the fact that so many of the poverty-stricken citizens have none, or very limited options, when it comes to accessing care. This is a result of many factors, mainly cost of procedures, transportation and time efficiency of the private hospitals. Although hospital administrators or clinicians wouldn't want to admit it, there are certain "types" of patients that get in to see the doctor before others-and this is not always based on the severity of their condition.
Public hospitals do our country a great service in taking all patients, regardless of insurance or income level. That is a huge part of why ERs are overflowing-because those patients who can't pay are automatically pushed into these waiting rooms. What many people fail to acknowledge, however, is that eventually these patients are seen and given care. That cannot be said for private hospitals. It may not be common yet private hospital ERs do turn patients away due to insurance purposes.
I have personally experienced the problems of the private hospital system. Working as an EMT in a city, there has been more than one occasion that we were in route to a private hospital with a patient and had to turn all the way around, across town and out of the way to the public just because the patient couldn't afford care. That is absurd. I understand and agree that when you are making an appointment to see a doctor or specialist, they need to be covered by your insurance. But how can anyone turn away a person in an emergency situation all because of costs?? Maybe this is something that needs to be changed among all Emergency Rooms in both public and private hospitals. Would clinicians and hospital administrators rather have deaths than care for those who simply have the wrong insurance???

Public Hospitals on the Decline

When public hopsitals close, the services provided to the poor uninsured disappear.  I mean, when MLK Harbor closed, the first thing that came into my mind was that people in that community will either 1) not get any medical attention when needed due to the inconvience of traveling to another hopsital or 2) these people will travel to another hospitals ER creating overcrowding and longer wait times, more frustrated patients, overworked nurses, and an extremely tense hospital environment.  This can cause people to lose more trust and patience with the healthcare system, it might even be a create a new tension in certain communities.  I feel like most people that use public hospital ERs as a primary care location feel somewhat more less important to the healthcare system.  Some may feel like they are not looked down upon by society because of their SES or education, closing the hospitals may further this sentiment and they may feel left behind--as if their health does not matter.  They ulitmately will feel more vulnerable and helpless. In terms of the healthcare system, I think closing public hospitals worsens the already depressing situation.  It would probably increase medical costs in that community. 

Negligence

The impact that this trend will have on the population is to look into other sources that will provide the care offered by hospitals (whether it means going to another country to get the services required). Just as the system falters year after year there are no new systems that come to the rescue and develop organizations that can handle the everlasting effects of hospitals closing. As these resources decrease which are so critical to poor, uninsured, and life treating conditions it has started to take a toll not only on the pockets of millions of Americans but also on their well being of many Americans. So, when the equation is not balanced and a child can point it out then invasive procedures will be put in place so that we can jump start this cracked, complicated, expensive health care system. However, we have known that our system is messed up and yet we neglect the signs of a serious heart attack administration after administration. So I guess we'll just have to wait around till we can no longer patch up the good ol’ heart and wait for chaos to erupt.

We Need Public Hospitals More than Ever in this Economy

The public hospitals closings' impact on the population and the health care system is that less people will get health care (particularly the poor). For example, with MLK-Harbor Hospital closing, those patients that are gunshot victims and are poor but not quite poor enough to qualify for Medicaid for example will have to be sent to an ER at a private hospital. These private hospitals can't refuse to accept a dying person. Somebody will be picking up the bill for this gunshot victim because the gunshot victim will not be able to afford their treatment. Most likely the bill will be picked up by private hospital/health care insurance companies, and those people who pay the premiums for their health care at the private hospitals. This means that the premiums will go higher and less people will be able to afford health care. This means that those who can no longer afford health insurance will join the un-insured. This could end up to be a vicious cycle. Particularly in this economy, there will many more people who can't afford health insurance. Hence, when people need public hospitals the most, more and more public hospitals are closing. What a shame!

county hospital

Whenever I hear about or talk to someone who had a medical emergency, one of the first sentiments expressed is "All I was hoping is that I didn't get sent to county".  I have also retained this fear from time to time due to my preconceived notion that LA county hospital has subpar facilities and is overwrought with patients therefore rendering them little resources to adequately treat me if I ever got shot or some other terrible outcome within their jurisdiction.  Needless to say our county hospital is not my first choice of first aid, however it isn't due to lack of effort on all fronts.  If I remember correctly, MLK was closed down due to inadequate facilities and a slew of scandals stemming from poor treatment and improper protocols.  It's possible that one of the reasons for this was underfunding, however I don't think the answer should be to pump more money into a faulty system.  In recent class discussions we talked about a need for crisis before reform can happen and I think this is one of the times this mantra rings true.  The more obvious the failures of our health care system become, the sooner we will all see the necessity for drastic changes.  In accord with our current president, I think change needs to happen now and from his speech tonight, I think those changes are actually going to take form soon.    

Public Hospitals on the Decline

It's an unfortunate situation that will continue if the economy doesn't shape up soon. Hospitals need money just as much as anyone else in these hard times and they're finding that increased costs along with fewer patients with health insurance (many because of unemployment) is taking a toll on the public hospital system. It's a serious toll indeed. The government isn't providing sufficient funding either, so these hospitals are forced to close their doors to the communities that need them the most: low income communities. It's a sad correlation, the poorer are getting sicker and their ability to survive is dwindling simply because hospitals don't have the funds to provide them their basic right to a healthy life. I hope this trend is a major signal to the government, highlighting the very real need for a better insurance system and a better public hospital system. It's truly a disgrace that we can't provide our citizens with the health care that they need and instead have them become increasingly sick or waiting in overcrowded and understaffed hospitals that, by necessity, have to worry more about getting them in and out quickly than about making sure they're healthy and able. 

The Dregs of the Patient Pool

I think Hailin (and other posters) are absolutely right in trying to determine the cause for the decrease in the number of public hospitals before speculating on whether the trend is good or bad. After all, it would not be a tragedy for public hospitals to close if the demand for them decreases. On the other hand, if public hospitals are truly in short supply, and cannot be replaced by urgent care centers or community clinics, then the only way to reverse this trend is to understand what's driving it.

This is clearly a complicated issue on which (I'm sure) hundreds of academic papers have been written, but I think it's safe to say that one of major causes of the decline is the enormous pressure on local, state, and federal governments to contain the rising costs of healthcare. 

Let's consider the hypothetical situation of some generic public hospital, called Hospital X. 

Hospital X serves a population of 100 patients. These patients have varying degrees of health: some are only occasional outpatients, while others only ever grace the ED, and still others have serious conditions that require hospitalization. Most patients are able to pay, but some are not. State and federal dollars (that is, tax dollars) comprise the bulk of Hospital X's budget.

Now, let's say the state government decides that it needs to increase access to care for its underserved and uninsured population (we'll pretend it's a surplus year for the state budget). It does so by offering higher reimbursement rates or other incentives for Medicare and Medicaid patients (or those on other government programs). This is good news for healthcare providers  everywhere. Hospital X predicts that it will generate more revenue, and therefore become a more sustainable institution. However, the private sector also realizes that taking on these Medicare and Medicaid patients is not as bad as it used to be. They begin to dip into Hospital X's health consumer pool, and draw away some of the patients that normally go to Hospital X for their care.

As far as the patients are concerned, this is not a bad development. In fact, this shift from public to private healthcare is not necessarily a bad development overall, so long as private care is reasonably accessible and reasonably affordable.

Crucially, however, the private sector does not take on all of Hospital X's patients. It only takes those that are insured (by government programs or otherwise) or have some other means to pay. Let's say 60 of Hospital X's original 100 patients are of this type. This leaves Hospital X with 40 patients who are 1) the sickest of all the patients, therefore requiring the most intensive and expensive interventions; and 2) the poorest of all the patients, therefore unable to pay for those intensive and expensive services.

However, Hospital X is required by law to treat these 40 patients, who now largely enter Hospital X through its emergency department rather than its outpatient clinic. Consequently, they are sicker than before, because they have waited until the last possible moment to get care.

Clearly, this is not financially viable. But it gets worse: now some employers stop offering health coverage to their employees, and the number of uninsured patients rises. However, because the government incentives for providers to take on Medicare and Medicaid patients remains constant (or even increase), the 60 patients that Hospital X used to see are now replaced with 60 new patients: those that are just as sick and unable to pay as the 40 it was left with before.

Hospital X is now treating the patients that no one else wants to touch. While this is admirable, it probably isn't intentional. Nor is it sustainable. Now that Hospital X is treating drug addicts, gangsters, and the like, its reputation begins to sink. Hospital X is not safe, Hospital X's staff is always overworked and won't give you the time of day, Hospital X's ED is overrun all the time, etc., etc. Those patients that can switch over to the private sector now do so avidly.

So what can Hospital X do? 

I would argue that this is not the right question. In the midst of the economic and political forces that robbed it of a diverse (and paying) patient clientele to begin with, there is probably little that it can do on its own to resolve its financial burdens over the long term. A more appropriate question is, "How can the healthcare system be restructured to make public hospitals like Hospital X more viable?"

Clearly this is also a very complex question; if it weren't, we would have come up with an answer already. Knowing what little I do, I am of the opinion that bolstering the safety net is not the answer. Safety nets are not supposed to be stolid, massive, or otherwise "bolstered." They are there as a last resort. They should constitute a minor (albeit critical) part of a functioning healthcare system. It is primary or outpatient care that should be bolstered. We do not want to create even more public emergency rooms to meet an increase in demand for ER services. Erecting another hundred public hospitals to create the capacity to serve a hundred times as many poor or critically ill patients is not solving anything; it is just as reactive and short-sighted a solution as using expensive surgeries to curb the obesity epidemic. Why not figure out why so many safety nets are even needed in the first place? Surely, under a functioning healthcare system, there should not be so many patients that feel they can only count on the ED for care. Surely, there should not be so much uncompensated care that the institutions that take on underserved patients are in perpetually danger of insolvency. We should not be asking ourselves, "How do we save the public hospitals?" but "Why do they need to be saved?"  

Depressing...

America is a capitalism country where it applies to Darwin's "survival of the fitness". It has the gap between rich and poor, and unfortunately the gap is getting bigger as the economy goes down. The gap between rich and poor people's life quality will continue and increase because it is very difficult to improve our economy issue within a year. And it is not easy to change our health care system within a very short period of time. It is very depressing, because we will just see the trend going linear (increase the number of uninsured, poor, and sick; increase the number of public hospitals that are out of business due to budget). I wish our government can spare more funding on the poor, because they need the government much more than the rich people. In addition, there are large percentage of poor in this country while the "rich" are just the few.

I agree with "Sindy", we need tot ake action for this failing health care system, and health care professions should be the activists for it. It might be one of the ways to save our economy, country.

Increasing disparities

As more pubic hospitals close down, the number of uninsured will have to seek medical care in remaining public hospitals, free clinics, Medicare and Medical. Unless the economy picks up and jobs begin to insure the uninsured, overcrowding will cause the services of these programs to deteriorate. In my opinion, there has to come a point when the masses mobilize and demand the government to make the changes that will benefit all. It is sad to see that the closing of hospitals is mostly affecting disadvantaged communities. The health disparities by race, ethnicity, and income only seem to be growing with this failing system. The continued decrease in public hospitals should be a sign for government officials to realize the failure in the current health care system and step in for the interest of the public.

What causes the decline?

The decline in numbers of public hospital makes it harder for the poor and uninsured to receive medical services, as they could not afford to got to for-profit hospitals.  We may predict the average health status in the population going down as the result.  Before considering the impact, let's try to make it clear the reason for decline.

I searched step by step and got an acceptable answer.  First, why are public hospitals shutting down?  One answer would be that they are facing bankruptcy as it's hard to run without making any profit, also the funding from government is quite limited.  This is absolutely right, but there's another factor deteriorating the situation: increase in uninsured.  As public hospitals are the best choise for them, they are actually accelerating the financial crisis in public hospitals.  

Here comes the next question: why are numbers of uninsured increasing? The first word that comes to my mind is: unemployment.  Since employer-sponsored insurance is a basic approach for most working population, and rising insurance premiums are a heavy burden for an individual or a family, it's easy to understand those who lose jobs to be uninsured and go to public hospital.  For those employed, there's also a problem.  Many new firms are reluctant to introcduce health insurances as "It’s much better for employee morale if a small-business owner never offers health benefits, than it is to offer them and then be forced to take it away because it is too expensive to continue".  So, the uninsured rate is also increasing in employed population.

If we go deeper into this, we would find that it's all connected with economy.  It has a great influence on the health care system.  So things always come together: unemployment, fewer income, less access to medical care, worse health status.

Remedy the health care system is acceptable but not the best way, what we would like to see is the economy going up.

Public Hospitals on the Decline

The fact is that with rising costs, public hospitals are often times forced to shut their doors as they can not afford to provide cheap or free health care to the uninsured and under-served. It is unfortunate that health care has essentially become a business. And like any other business in the world, hospitals must have enough revenue to pay its employees.


With little or no income, some public hospitals may cut the number of attending physicians like K-Mart would cut the number of employees when it’s unable to generate adequate funds. The critical difference is that with fewer K-Mart employees, grandma Jenkins may not get greeted near K-Mart’s entrance, but with fewer health care professionals in a public hospital, little Timmy may not get that bone marrow transplant soon enough. Although this may be a far-fetched and rather radical example, the point is that public hospitals are often times unable to provide quality care to the deserving poor and uninsured population- often due to business-related issues.


Clearly, this is a problem. More than two hundred years ago, this nation was founded upon the principle of equality for all. But clearly there is a huge discrepancy between private and public hospitals. With more public hospitals shutting their doors, more poor and uninsured individuals are falling through the cracks and are being neglected the quality health care that they direly need and deserve. This inadequacy is fundamentally plaguing our health care system as the well-resourced private hospital goers are receiving quality health care and the public hospital visitors are forced to bare the brunt of our double-standard health care system.

With little or no income, some public hospitals may cut the number of attending physicians like K-Mart would cut the number of employees when it’s unable to generate adequate funds. The critical difference is that with fewer K-Mart employees, grandma Jenkins may not get greeted near K-Mart’s entrance, but with fewer health care professionals in a public hospital, little Timmy may not get that bone marrow transplant soon enough. Although this may be a far-fetched and rather radical example, the point is that public hospitals are often times unable to provide quality care to the deserving poor and uninsured population- often due to business-related issues.

Clearly, this is a problem. More than two hundred years ago, this nation was founded upon the principle of equality for all. But clearly there is a huge discrepancy between private and public hospitals. With more public hospitals shutting their doors, more poor and uninsured individuals are falling through the cracks and are being neglected the quality health care that they direly need and deserve. This inadequacy is fundamentally plaguing our health care system as the well-resourced private hospital goers are receiving quality health care and the public hospital visitors are forced to bare the brunt of our double-standard health care system.

Private clinics may be the future

The setting: Each county is responsible for the health of its population and this week’s article, Crisis and Commitment, shows the history of LA County’s close calls with its health care system, concerning its fiscal security. The article shows that they are always concerned about balancing the county health care budget as well as the health of its population.

They definitely that they do not take closing hospitals lightly.

The problem: With the closures of county clinics and hospitals, like MLK in 2007, the county of Los Angeles DHS was trying to secure its most critical elements of its health care, like their "trauma, hospital and specialty care services," according the the LA county officials, according to an LA Times article. Furthermore, they showed commitment to close the health care gap for the poor and the rest of the population by wanting to supplement existing private clinics to care for indigent population. They better. They should prevent the feelings that lead up to civil explosions like the Watts Riots. MLK was built as LA County’s reaction to these Riots.

Part of the solution: The idea of having health care satellites like these private health care clinics sounds pleasant enough. Closer, more personal health care sounds as nice as going to the neighborhood pharmacy. On top of that, the county is saving money by substituting these for its own, more costly, county clinics, which are currently closing in the tens per year. (In case anyone is worried about areas that do not have private clinics, the LA Times article mentioned William T. Fujioka, the county’s chief executive, who said that the county clinics would not close in areas that already do not have private clinics, like the Antelope Valley). I do not see private clinics as a complete solution, however.

Some questions still exist: How will a private clinic, which is not required to accept indigent patients, will accept the uninsured patients which have been displaced by hospital closures? Even though the county will contract with these clinics, will they be able to accommodate for all the displaced patients?

Vision for the future: There is an article that mentions retail clinics inside neighborhood retail stores like Walmart, CVS pharmacy and Walgreen's. They offer preventative services for now but in the future, I can see them offering more comprehensive types of health services.

http://articles.latimes.com/2008/feb/14/local/me-clinics14
http://www.aishealth.com/Bnow/hbd020509.html

Lose-Lose Situation for the Uninsured

As the number of public hospitals decline so will our health care system. By far, the vast majority of people that seek out medical services and treatment at public hospitals are those of low socioeconomic status, as they are predominantly uninsured or inadequately insured. As a result of this steady decline in public hospitals I believe that the disparity gap in access to even the most basic of health care services is only going to widen. Most people who are uninsured typically do not have a primary care physician and thus seek out public hospitals as their primary source of care (typically by going to the Emergency Department). Now that their options are slowly starting to wane, what little access to care they had to begin with is only going to diminish over time. They are going to be forced to go greater lengths out of their way just to be able to utilize the health care that many of us who are insured have the luxury of accessing within a reasonable distance and time frame. For example, with the closure of MLK-Harbor who knows how far the next closest public hospital is? In addition, will this public hospital even be able to properly accommodate this sudden influx of new patients seeing as the resources they have just to cater to their own community are barely enough in the first place? Moreover, will this newly care-displaced population have the financial and/or temporal means to even get to this other public hospital? Talk about a lose-lose situation.

Although the fact that we live in a capitalistic society that emphasizes competition and a free market economy can have positive effects on our economy in the long run, it seems to be having the opposite effect on our health care system. Instead of treating health care as a right, it is being treated as a commodity to be bought and sold. While this does not affect to a large degree those who are fortunate enough to be insured, it is having detrimental effects on the quality of life of the uninsured, a population which, in this economy is growing by the day.

Let's be honest: Hospitals are big business

I agree with much that has been posted prior.  Clearly, the need for public hospitals is tantamount for the overall health of the American society.  We have a significant problem in that our foremost goal as a nation is towards our economic well-being and free enterprise, capitalistic system.  Just look at the current financial crisis and how media coverage is being dedicated to it. Clearly, $$$ is our foremost concern as a nation. 

Hospitals nowadays are big business.  They're run like businesses in that they attempt to make profits, pay stakeholders, have CEOs and CFOs, and even advertise (often times with catchy slogans and mass media campaigns).  It's fascinating to me how new cancer treatment, heart clinics, and dialysis centers seem to crop up on a daily basis in even the smallest of communities.  It's a shame that this is the way it is, but I'd like to think that there's a better path to wellness then profiting off others illnesses.  

At some point, we, as a nation, will realize that action must be taken to increase the amount of public hospitals to people who need them most.  If it requires higher taxation, so be it.   The U.S., for a developed country, already offers one of the lowest income tax rates in the world and if we all had to pay more to get higher quality care and access to care, then I would be all for it. Hopefully, we collectively reach a conclusion (quickly) in order to fix the current issues that will burgeon as our society continues to age, and disparities between the "haves" (those with healthcare) and the "have-nots" continues to grow.  

Level the hospital playing field

So, public hospitals are on the decline.  Private hospitals steal the medicare/medicaid/SCHIP patients, because they, in a round-a-bout way, actually result in some money for the hospitals who take care of them.  Which leaves public hospitals as the only option for the uninsured, and actually, leaves the uninsured as the main option for the public hospitals to exist.

What is wrong with this picture?  The fact that there isn't the freedom in the health care system in this country for patients to receive care wherever they choose.  There is all this underlying "you have these options for hospitals that this insurance company contracts with, and if you don't have insurance, then you better go here, because they will actually treat you, and oh wait, if you go to the ER at said public hospital, they can't turn you away" mentality that is driving the country's hospitals in between a rock and a hard place.

Any decline in public hospitals means a decline in what little availability to health care that the uninsured and lower SES patients have.  Any decline in health care availability is a bad thing for the state of this county, state, and country.  Something has to change.  Probably the change needs to start at the very top, otherwise nothing will come of it.  This change needs to somehow level the playing field between public and private hospitals, perhaps by enacting a universal health care plan.  Whatever happens, the path the hospitals are on right now is not the best for the people they are (supposedly) trying to serve.

PUBLIC HOSPITALS ON THE DECLINE

Patients who need health care the most are having fewer options due to closing public hospitals. The uninsured and underinsured are clearly impacted since they no longer have access to care and are less likely to utilize services. When they do seek medical help, they are usually in more advanced stages of illness and injury. They may have to turn to local private hospitals. However, these services are extremely costly and are already overflowing with patients due to the recent closure of public hospitals in the area. Quality of care would also decrease since so many patients are now filing into one particular hospital. A decline in the number of public hospitals also has a dramatic impact on the residency programs in the area. Most public hospitals are located in underserved neighborhoods where services are needed most. Closure would decrease resident program positions and exposure to urban public health care sites that could have very well influenced their future practice choices.

Where do all the patients go?

Public hospitals, which have long been known to provide medical care to Americans of all walks, are being forced to shut down. There are many reasons that contribute to the decline of public hospitals. It’s a combination of budget cuts at almost every level of government, increased number of uninsured patients, and the increased demand on the emergency room. Without the public hospitals, private hospitals are forced to assume the burden. But what happens to the patients who were from a now closed public hospital? It has been suggested that they suffer declines in outpatient and inpatient medical care, and overall health status. Looking at the broader effects of fewer public hospitals, it is suggested that they could ultimately drive up the cost of U.S. health care, because poor patients will have to seek their medical care elsewhere (i.e. emergency rooms at other hospitals).

No hospital, no ER.

The first thing that came to my mind at the mention of the closing of hospitals was the fact that a large number of people rely on hospitals as their primary form of healthcare, as emergency rooms are required by law to treat anyone who comes in. The absence of emergency rooms could leave many people without proper medical care, and also has the effect of increasing the burden upon remaining hospitals, as they would be forced to serve larger numbers of people without increasing their number of beds/capacity for patients. This dynamic is disadvantageous for hospitals as well as patients; hospitals seldom provide the best care they can when they are over-crowded, and patients face longer waiting times and sub-par service when they are sharing an Emergency Room that is over capacity. There is, however, a chicken and egg question here: are hospitals closing because of a failing healthcare system, or is the failing healthcare system forcing hospitals to close? It may be a difficult question, but it seems unlikely that closing one hospital after another will benefit the general population in any significant way.

The Effect of Hospital Ownership Conversions

The overall effect of hospital ownership conversion from public to private will be significant in terms of community benefits.

From September 1997 through January 2003, researchers at Brandeis University, Heller School for Social Policy and Management, Cambridge, Mass., studied how a change in ownership from nonprofit to for-profit status ("conversion") affected hospitals' provision of community benefits, financial performance and relationships with other health care providers.

The project included a nationwide study of all 709 hospital conversions between 1990 and 2001 as well as in-depth case studies of eight hospitals.

The result was published by The Robert Wood Johnson Foundation (RWJF) in Oct 3, 2005.

Key Findings

• Uncompensated care levels dropped when a nonprofit hospital converted to for-profit ownership.

• The most significant decreases in uncompensated care occurred when not-for-profit hospitals converted to for-profit chain-owned facilities.

• Conversion affected the hospital's collaborative and competitive behavior toward other providers and organizations in the community.

• Conversion hospitals, may exceeded the nonprofit counterparts in terms of financial contribution, but they did not substitute for the hospital's role as a community partner.

I also think the impact of decreasing public hospitals due to conversion to private ones will reduce the levels of community benefit activities, since these are generally thought to be unprofitable and therefore incompatible with for-profit hospitals’ presumptive goal of profit maximization.

The community will come up short—uninsured and low-income people receive less care, all patients have reduced access to specialized emergency services, and society-at-large foregoes the benefits of medical education and research.

No end in sight

Well, like Amy said, the decline in access to public hospital/hospice care means that the low-income, uninsured population is losing their safety net. And conjunctively, this drives up healthcare costs because these people will be turning to emergency rooms at other hospitals to substitute for their primary care providers. There is a really old study from 1990 by Bindman et al. that compared the health status of residents of Shasta and San Luis Obispo counties when the former's public hospital was shut down, but the latter's was not. The hospital patrons of both counties were surveyed initially, and then followed-up with a year later. What they found was that:

"At follow-up, the percentage of patients from Shasta County who reported no regular provider increased from 14.0 to 27.7 and the percentage who reported they were denied care rose from 10.8 to 16.9. Meanwhile, patients in San Luis Obispo County reported improved access to a regular provider and the level of denied care was unchanged. Patients in Shasta County had significant declines on the Medical Outcomes Study Short Form in health perception, social and role function, and increases in pain as compared with those patients in San Luis Obispo County."

Now, this is an outdated study, but it basically shows how taking away access to healthcare providers and services impacts a population. Even when these resources are not completely eliminated but simply downsized, this forces the public hospitals to go into "battlefield mode," triaging their patients so that the ones with the most severe, life-threatening injuries are treated right away while those with less pressing (but nonetheless still important) problems are constantly relegated to the waiting area, sometimes for months at a time.

This whole subject is a weighty issue with no clear-cut solution. There are some nonprofit hospital systems out there with huge administrative pay-offs, notably BJC HealthCare, whose CEO's salary is upwards of $1.8 million a year. I think he could stand to receive a severely-reduced paycheck. Or, maybe if private hospitals operated one day out of the week on a non-profit basis, this could help alleviate some of the financial burden that public hospitals are facing. I doubt private hospitals are willing to do this, or if most of them are in the appropriate geographic areas to even reach the low SES communities, but it's just an idea.

Less facilities, more death

A lot of people can't afford health care, a lot can't even get insurance to dampen some of the costs of health care.  Public hospitals and clinics offer a ray of hope to that group.  All this aside,

the fundamental idea of closing any hospitals will definitely result in less facilities for people to access, more deaths because the hospitals are fewer and farther between in case of emergencies, and in current hospitals there will be more strain on the ER and other facilities because where are all those hundreds of people who used to go to the old hospital going to go?  They have to go somewhere...and they go to the next closest hospital which is already packed.  So all the extra pressure, people to take care of, will decrease the care and quality at the still open hospitals resulting in more deaths there as well.  Its a vicious cycle...not to mention all that pressure causing the already huge shortage of nurses and other providers to quit their jobs because they cant take it anymore.  

Its a vicious downward spiral.

www.larouchepub.com/other/2001/2819_death_toll.html

Shake ya tailfeather

Lets just say that you lived on the east coast, and then you found out you got into USC for a masters program.  Now, the question is, where are you going to live?  You find out that you have an aunt and uncle out here that is willing to post you up in their house for FREE!  Whoa, whoa, now thats pretty awesome.  I guess its not 100% awesome just cause you cant throw ridiculous parties and what not, but hey, its free living, right?  Thats one less thing you have to worry about.  More money to spend on the night life, the ladies, the drinks, the partying, FOOD, and... school and books.  Haha.  They cook you meals, do some of your laundry, and clean your room!  Good deal!  Ok so anyways, you go throughout the semester, and then halfway through the semester you find out that your aunt and uncle are selling the house to go buy a boat and live out on the water.  They said the new buyer is still willing to let you live in the same place so you dont have to hassle and try and find a new place.  Sounds like a plan, right?  So the time comes for the the new owner to move in.  You say your hello's when he comes into the house, and you start walking back to your room, but then all of a sudden you hear him say, "So how much will you be paying for rent?  I know youre a student, so I'll try and hook you up"  You think to yourself "@#%#%@^$$#^#&&!!!  It was free before, and now I have to pay?!  USC is already taking all of my money!!!"  Now, your aunt and uncle were putting you up for free, no questions asked.  They even cooked you meals and did your laundry!  Then all of a sudden this new guy comes in and starts asking for money?!  What are you supposed to do?  Its mid semester and you dont really have time to be looking for places and moving right now.  It seems that he has good intentions to give me a good price for rent, but we're not even family so he doesnt really have any obligation to let me stay for free.  And since hes not family, hes gotta look out for himself more too.  

These public hospitals are somewhat like your aunt and uncle, and the private hospitals buying up these public hospitals are like the new owner of the house.  So where are all of these kids living with their relatives going to go now?  Theyre going to have to sell out and pay the cash to these privately owned places (not relatives).  This is exactly whats happening to our health care system.  Its getting more difficult for these public hospitals to stay in business because private hospitals are jacking their medicaid patients to make more income now too!  These low/no income patients are now going to have to either shell out the money to get insurance, go to a private hospital, or general practice clinic.  No matter how much the private hospitals are going to try and help these patients, the hospitals are still about the bottom line.  Make that money!  They sure as heck arent going to give out free health care.  Overall, I think that buying up and closing these public hospitals are gonna make more the private hospitals more money, just cause they will be taking the overflow of patients.  

...But who will save these people with no money for health care?  Who will let you move in for free?!  I dont think anyone will be letting you move in for free, but youre going to have to find a place farther from school, a lot smaller, but isnt too expensive and not too shabby.  More family practice clinics will be gaining patients from these public hospital closings.  Other than webmd and asking friends to treat them, this is the next best option from going to a hospital.  

Summary of my randomness and blabber:

Picutre this:  A great girl who would not survive not being in a relationship just got dumped by her boyfriend who pretty much paid for all of her stuff.  Now she has a choice, which is either to get with that guy who has always had his eye on her, hes really rich but hes really tight with his money, so she'd have to pay for a lot of stuff when they go out, or she could get with that guy who wasnt as popular or rich, but he'd take real good care of her and she'd only have to pay for stuff but it wouldnt be as expensive.  

Ex-boyfriend: public hospital

Rich guy:  private hospital

Not as rich or popular guy:  private practice clinics

Cartoon!

Public....private....which way do I go??