What is the issue?
There has been an increase in the number of hospital closures, like the recent Steward Healthcare bankruptcy, and that trend is likely to continue. Policymakers are increasingly tasked with trying to address the issues caused by these closures. But to do so effectively they must shift their focus from the narrow scope of “access to care,” and instead consider various other consequences of hospital closures that are currently largely overlooked but need to be part of policy discussions, including impact on physicians and nearby hospitals.
What does the research say?
The sweeping legislative initiatives that arose in response to the COVID-19 pandemic highlighted how various kinds of policy approaches succeeded or failed in providing needed patient care and institutional stability to hospitals. In a new paper, HKS’s Soroush Saghafian argues that current policies are inefficient partially because they are designed without a complete understanding of various implications of hospital closures. By gaining such understanding, policymakers can use more targeted approaches to providing positive healthcare outcomes in sensitive communities.
When hospitals do close, large-scale national-level data analysis by Saghafian and his former PhD student, Lina Song, shows that nearby hospitals often respond via “speed-up” procedures, which negatively impacts the quality of care delivered to patients. This stems from the fact that hospitals face spiked demand that needs to be met without additional capacity.
Policymakers should realize that doctors also respond by adapting to different care models or may seek to leave the profession after a hospital closing. Specialists, such as anesthesiologists, OBGYNs, and emergency doctors, are particularly harmed by hospital closures compared to general practitioners. As a result, the outcomes for those who need these services are also starker.
With tangible impacts on doctors, nearby hospitals, and the patients who need access to specific forms of care, Saghafian recommends that policymakers use broader sets of data in determining what policy actions best address hospital closure. Smarter ways of allocating limited funds to bail out specific hospitals predicted to be at risk, use of telehealth and community health solutions in specific geographical areas, and utilizing other policy solutions that take into account various overlooked aspects of closures can go a long way.
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