The Community Service Society of New York
10/29/2024 | Press release | Distributed by Public on 10/29/2024 07:10
Testimony: The Effects of Hospital Closues
October 29th, 2024
Testimony: The Effects of Hospital Closues
Mia Wagner
The Community Service Society of New York (CSS) would like to thank the Committees on Hospitals and the Committee on Health for holding this hearing.
CSS is a 180-year-old organization that seeks to build a more equitable New York for low- and moderate-income people. Annually, CSS helps over 130,000 New Yorkers enroll in health coverage, successfully use health insurance, resolve medical billing problems, and otherwise access care. We do this through a live-answer helpline and through our partnerships with over 50 community-based organizations working in every county of New York State. Annually, CSS and its partners save consumers over $80 million in health care costs.
Thanks to the generous support of the New York City Council, CSS coordinates the City Council-funded Managed Care Consumer Assistance Program (MCCAP), which has helped over 16,000 City residents enroll in coverage, access care, and resolve medical debt issues in partnership with 12 community-based organizations.
The majority of MCCAP clients are Medicaid recipients (40 percent), uninsured (25 percent) or Medicare recipients (15 percent). Over two-thirds of clients (67 percent) report a language other than English is spoken in the home including Spanish (34 percent), Korean (11 percent) and Polish (7 percent). Most clients (69 percent) who report race or ethnicity are New Yorkers of color. MCCAP clients are assisted with eligibility for health insurance, questions about accessing care and understanding the cost of care (41 percent). Many clients have questions about the complexity of the health care system (38 percent). MCCAP serves clients in all 5 boroughs: Queens (42 percent), Kings (19 percent), Manhattan (17 percent), Bronx (12 percent), and Staten Island (10 percent).
In the wake of the pandemic, MCCAP consumers have encountered a constantly changing landscape of health coverage and insurance eligibility rules, as well as hospital mergers and closures. MCCAP has been an invaluable resource to New Yorkers who have had to deal with complicated health care billing and access issues. We bring their insights and experiences to our testimony on the important issue before the Council today.
I. Examining the Effects of Hospital Closures on Community Needs
Since 1996, over 50 hospitals have closed statewide with more than a third of these closures taking place in New York City.[1] In the past two decades over 21,000 beds were lost across New York State (from almost 74,000 in 2003 to just 53,000 in 2020).[2] A 2024 study found that 45 percent of rural hospitals across New York State are at risk of closing in the next 2- 3 years and 57 percent of rural hospitals are at risk of closing in the next 6-7 years.[3]
In June 2020, CSS issued the report How Structural Inequalities in New York's Health Care System Exacerbate Health Disparities During the COVID-19 Pandemic: A Call for Equitable Reform. This report documented that Black New Yorkers and other people of color had quadruple or double the COVID-19 mortality rate in the earliest days of the pandemic, when patients needed to rely on hospital-based care, when compared to White New Yorkers. This report linked the location of hospital closures to exacerbated health disparities and fatalities at the height of the COVID-19 pandemic. Hospital closures mostly occurred in poorer neighborhoods, neighborhoods where people of color live, and where there were fewer patients with health insurance or the means to pay for care. For example, the borough of Queens witnessed the closure of four safety-net hospitals (St. Joseph's in Fresh Meadows, 2004; Parkway in Forest Hills, 2008; Mary Immaculate in Jamaica, 2009; St. John's in Flushing, 2009), leaving Health + Hospitals/Elmhurst as the sole safety-net hospital serving one of the country's COVID-19 epicenters. As a result of these closures, hospital-based care is not equally, or even logically, distributed in New York State. For example, there are 1.5 beds per 1,000 people in Queens compared to 6.4 beds per 1,000 people in Manhattan.[4]
National research offers evidence that hospital closures reduce access to care, quality of care, and have negative economic impacts. As a result of hospital closures, there can be a reduction in access to emergency care at nearby hospitals,[5] decreased duration of service per patient at nearby hospitals,[6] and increased deaths from heart attacks and accidents in that community.[7] Closures are associated with a drop in quality-of-care measures,[8] increased mortality for certain conditions,[9] and contribute to increased numbers of ED visits.[10] Hospital closures are also known to have direct negative economic impacts including job losses,[11] reducing per-capita income, and increasing unemployment.[12]
Hospital closures in New York City lend credence to these national findings. For example, after the 2010 closure of St. Vincent's in Manhattan, four nearby hospitals saw statistically significant increases in emergency department (ED), inpatient, and ambulatory care, with biggest increases for ambulatory care. The hospitals closest to St. Vincent's had the biggest increase in ED and inpatient care.[13] When EDs at Bellevue and NYU Langone Medical Center were closed following hurricane Sandy, patients were redistributed to other hospitals for emergency care. Patients of Bellevue tended to be younger, people of color, Medicaid or self-pay patients and lived outside of Manhattan. While previous patients of both closed emergency departments were redistributed to nearby hospitals, previous patients of Bellevue, a public hospital, were more likely to get care at other public hospitals even in cases when private hospitals were closer.[14]
As with the case of Beth Israel, hospital closures often ensue from mergers and acquisitions, especially in rural and underserved areas. When hospitals are acquired, units including intensive care, labor and delivery, and psychiatric care may be closed, forcing patients to travel out of their communities to access this care.[15] Further, research shows that hospital consolidation leads to layoffs of health care workers and higher prices. The increased health care spending that results from consolidation can increase costs for families, employers, states, and public programs.[16] Several studies have found an association between hospital consolidation and rising premiums.[17] Hospital consolidation has also been linked to a decrease in wages among non-health care workers with Employer Sponsored Insurance.[18]
Additionally, there are significant downstream effects of hospital consolidation and closures. A 2024 study on the impact of hospital consolidation found that when exposed to a one percent increase in health care prices, employers outside the health care industry reduced their payroll by over a third of one percent (0.37 percent). These results suggest that a single hospital merger can lead to $6 million in forgone wages, a $1.3 million reduction in federal income tax revenue, and job losses due to the strain high health care prices put on employers. Growing literature has documented that individuals who experience job loss can experience social consequences, increasing risk of premature mortality, particularly suicide, overdose, and liver disease. Researchers estimate that a 1 percent increase in health care prices leads to a 2.7 percent increase in deaths from suicides and overdoses, implying that approximately one in 140 individuals who become unemployed after health care prices increase die from suicide or a drug overdose.[19] Given that hospital mergers often lead to closures, and that closures further consolidate the market, is important to consider the broad economic and public health implications of hospital closures.
Both the New York City experience with prior closures and the national research literature establish that hospital closures adversely impact their communities. In the past year, Mount Sinai has proceeded with its unilateral attempt to close Beth Israel hospital in downtown Manhattan. However, this closure has been challenged and currently Beth Israel remains open and accepting patients.[20] The distribution of hospital beds in Manhattan is uneven and inequitable, while the Upper East Side is over-bedded, downtown Manhattan has far fewer beds. As Lois Uttley with the Community Voices for Health System Accountability (CVHSA) has testified, the Upper East Side has over 10 hospital beds per 1,000 people and the Lower East Side and Chinatown have less than one hospital bed per 1,000 people.[21] The City Council should pass resolutions 0022-2024 and 0023-2024 which would call on the State and Mount Sinai Health System to keep the 16th Street Mount Sinai Beth Israel hospital campus open.
II. Local Input for Community Healthcare Act
The City Council should also consider passing Resolution 0339-2024 urging Governor Hochul to sign the Local Input in Community Healthcare Act (LICH S.2085/A.1633). This bill would provide public notice and public engagement when a general hospital seeks to close or close a unit that provides maternity, mental health, or substance use care. This legislation will address gaps in the current review of proposed hospital and unit closures, making communities key stakeholders in a decision-making process.
Thank you for the opportunity to submit this testimony today. Should you have any questions, please do not hesitate to reach out to Mia Wagner at [email protected].
Notes
1. CSS researchers compiled press coverage of hospital closures throughout the state that took place between 1996 and 2024.
2. Dunker, Amanda, How Structural Inequalities In New York's Health Care System Exacerbate Health Disparities During the COVID-19 Pandemic: A Call for Equitable Reform, June 2020, Community Service Society, https://www.cssny.org/publications/entry/how-structural-inequalities-in-new-yorks-health-care-system-exacerbateheal.
3. Gamble, Molly, 25 states at most risk of rural hospital closures, Becker's Hospital Review, April 2024, https://www.beckershospitalreview.com/finance/25-states-at-most-risk-of-rural-hospital-closures.html.
4. See n. 2, supra.
5. Wishner, Jane, A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies, July 2016, Kaiser Family Foundation, https://www.urban.org/sites/default/files/publication/82511/2000857-brief-a-lookat-rural-hospital-closures-and-implications-for-access-to-care.pdf.
6. Song, Lina, The Spillover Effects of Hospital Closures on Efficiency and Quality of Other Hospitals, February 2023, Harvard Kennedy School, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3318609.
7. Buchmueller, Thomas C., How far to the hospital: The effect of hospital closures on access to care, July 2006, Elsevier Journal of Health Economics, https://www.sciencedirect.com/science/article/abs/pii/S0167629605001116?via%3Dihub.
8. See n. 6, supra.
9. Gujral, Kritee, Impact of Rural and Urban Hospital Closures on Inpatient Mortality, August 2019, National Bureau of Economic Research, https://www.nber.org/system/files/working_papers/w26182/w26182.pdf.
10. Lee, David C., The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis, December 2015, Population Health Management, https://www.liebertpub.com/doi/10.1089/pop.2014.0123.
11. See n. 5, supra.
12. Holmes, George M., The Effect of Rural Hospital Closures on Community Economic Health, January 2006, Health Services Research, https://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2005.00497.x.
13. Garg, N. Hospital Closure and Insights Into Patient Dispersion, 2015, Applied Clinical Informatics, https://www.thieme-connect.de/products/ejournals/abstract/10.4338/ACI-2014-10-RA-0090.
14. Lee, David C., Redistribution of Emergency Department Patients After Disaster-related Closures of a Public Versus Private Hospital In New York City, 2015, Disaster Med Public Health Prep, https://pubmed.ncbi.nlm.nih.gov/25777992/.
15. Levinson, Zachary, Ten Things to Know About Consolidation In Health Care Provider Markets, KFF, April 2024, https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-providermarkets/.
16. Liu, Jodi L., Environmental Scan on Consolidation Trends and Impacts In Health Care Markets, RAND, September 2022, https://www.rand.org/pubs/research_reports/RRA1820-1.html.
17. Trish, Erin E., How do health Insurer market concentration and bargaining power with hospitals affect health Insurance premiums?, Science Direct, July 2015, https://www.sciencedirect.com/science/article/abs/pii/S0167629615000375?via%3Dihub.
18. Arnold, Daniel, Who pays for health care costs?, RAND, July 2020 https://www.rand.org/pubs/working_papers/WRA621-2.html
19. Brot-Goldberg, Zarek, Who Pays for Rising Health Care Prices? Evidence from Hospital Mergers, Yale Tobin Center for Economic Policy, June 2024, https://www.nber.org/papers/w32613.
20. Goldstein, Joseph, New York Will Allow Beth Israel Hospital to Close, July 2024, New York Times, https://www.nytimes.com/2024/07/26/nyregion/mount-sinai-beth-israel-hospital-closure.html.
21. See written testimony of Lois Uttley, MPP for the October 29, 2024 New York City Council Committees on Hospitals and Health public hearing on the impact of hospital closures.