EDs Serving Medi-Cal, Minority Patients at Higher Risk of Closing


California hospital emergency departments that treat large numbers of blacks and Medi-Cal beneficiaries face a greater risk of closing than other EDs, according to a study published on Thursday in the Annals of Emergency Medicine, NPR's "Shots" reports. Medi-Cal is California's Medicaid program (Husted, "Shots," NPR, 11/16).

For the study, UC-San Francisco researchers used Office of Statewide Health Planning and Development data from 1998 to 2008. During this time, about 7% of EDs in California closed (Barr, Modern Healthcare, 11/16).

Key Findings

Renee Hsia -- a study author and assistant professor of emergency medicine at UCSF -- said financial factors, including how much hospitals relied on Medi-Cal payments, contributed to closures.

The study also found that for every 10% increase in black patients a hospital treated, its risk of closing its ED rose by 40%.

A 10% increase in Medi-Cal patients served correlated with a 17% increase in risk of ED closure, according to the study ("Shots," NPR, 11/16).

Researchers also found that:

  • For-profit hospitals had a 65% higher risk of closing their EDs than not-for-profit hospitals (Modern Healthcare, 11/16); and
  • Hospitals were more likely to add ED capacity in suburban neighborhoods where patients had private insurance (Cheung, Fierce Healthcare, 11/16).


Hsia said, "[ED] closures disproportionately affect vulnerable populations, but there are system-wide ripple effects felt everywhere."

Hsia said, "Future research on [ED] closures must examine their impact on health outcomes," adding, "It is concerning that the very populations who most rely on emergency services may experience declines in access to emergency care" (Fierce Healthcare, 11/16).

Hatti Hamlin
What part of this is "news"? Why wouldn't a for-profit hospital--or even a nonprofit one--be more likely to close an ED that disproportionately involves uncompensated or under-compensated care? Not only are the hospitals losing money in the ED, but if an uninsured/unable-to-pay patient needs to be admitted, they're going to lose even more money treating him. As California faces another wave of reductions in MediCal payments to providers, you can be assured even more ED's will close.

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