Historically, communities have not taken it well when their neighborhood hospital announces plans to close. In fact, I recall one instance from decades ago, in Florida, when plans to close a community medical center didn't just outrage citizens—it led to passionate protests, picketing and nearly sparked a riot. Back when hospitals were largely owned locally and run independently, this behavior was understandable, as people felt that it was their hospital and that they deserved to keep it.
Today, however, things have changed a great deal. When Steward Health Care System announced in early November that it planned to close 124-year-old Quincy (Mass.) Medical Center, after spending $100 million in a vain attempt to resurrect it after bankruptcy, neither the unions representing the facility's nearly 700 workers nor community leaders raised a protest. "It's met with great sadness, but I can't say that I'm extremely shocked," Quincy mayor Thomas Koch told The Boston Globe. Quincy, which has a population of roughly 93,000, will become the largest city in the state without a hospital.
If Quincy Medical Center closes on schedule, by the end of the year, it will actually be the third hospital in the state to shut down in 2014. Previously, rehab facility Radius Specialty Hospital and North Adams Regional Hospital ceased operations. And it should come as no surprise if other hospitals in QMC's region consider closure as well. More than a dozen are based within a 10-mile radius of the dying acute-care facility, and they're facing brutal competition.
Over-bedding not the real problem
But are closures like these a needed, albeit painful, step in creating a cost-effective healthcare system? At least one public health researcher rejects this idea completely. According to Alan Sager, PhD, who is interviewed in a fascinating blog appearing in Becker's Hospital Review, over-bedding isn't causing the high cost of US healthcare.
Dr. Sager, a professor with Boston University School of Public Health, notes that while the average US hospital occupancy rate is reported at about 65%, hospitals don't staff empty beds, and that the actual occupancy rate is close to 100% of staffed beds. So taking hospitals off the market doesn't eliminate excess capacity in most cases. (Here's excerpts from a paper Dr. Sager wrote on the subject back in 1997.)
Actually, the United States has about one-third fewer beds than the average rich democracy, according to the Organisation for Economic Co-operation and Development. In fact, beds per 1,000 people has fallen from 6.0 in 1980 to 3.1 per 1,000 in 2011, the most recent year for which the group has statistics.
What's more, reducing the number of hospital beds doesn't even reduce fixed costs, but rather, just shifts them around, Dr. Sager points out. When hospital close, patients typically rely more on teaching hospitals to get care, which is more expensive.
According to Dr. Sager, the questions health planners should be asking themselves, on a zip-code by zip-code basis, include: What physicians and what hospitals providing what services do we need and in what locations? How do we pay them in a way that attracts, retains and sustains them? How do we support them to deliver appropriate care efficiently and where it is needed?
As Dr. Sager sees it, the key to improving how our health system functions is to put the right caregivers in the right places, rather than letting market forces slash away at needed services. "Shooting at the wrong targets is unlikely to fix our very real healthcare problems," Sager says.