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Now, this is an outdated study, but it basically shows how taking away access to healthcare providers and services impacts a population.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.