Why are emergency rooms disappearing?

Emergency departments in nonrural areas have been closing down at an alarming rate -- and those declines may be linked to the poverty, racial demographics and competitiveness of a given area.

According to a study published online Tuesday in the Journal of the American Medical Association, emergency rooms have been closing down for two decades. In 1990, there were 2,446 hospitals in nonrural areas in the United States. In 2009, that number had dropped to 1,779 -- a decline of 27%. That’s a dangerous trend, the researchers point out, because “as the only place in the US health care system that serves all patients, emergency departments (EDs) are the ‘safety net of the safety net.’ ”

Patients whose Medicaid coverage isn’t accepted by private practitioners or who don’t have insurance often must turn to emergency rooms for urgent services. And turn to them they do: According to the study, even though just 4% of physicians work in hospital emergency rooms, they provide more acute care to Medicaid patients and the uninsured than all other physicians put together.

Based on a combination of information, including annual hospital surveys and financial information, researchers from UC San Francisco found that hospitals with larger minority populations were more likely to close than remain open (36%, compared with 31%), as were those in areas suffering from high poverty rates (37%, compared with 31%).

Also among the findings: that the emergency room closures depended on hospital-side factors as well: For-profit hospitals were more likely to close (26%, compared with 16% that remained open) and more likely to shut down in highly competitive areas (34%, compared with 17%).

The findings, the researchers concluded, “underscore that market-based approaches to health care do not ensure that care will be equitably distributed. In fact, the opposite may be true.”

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