245977 When hospitals leave the neighborhood: Do hospital closures impact racial/ethnic disparities in access to care

Monday, October 31, 2011

Kimberly Enard, PhD, MBA, MSHA , Center for Health Equity and Evaluation Research/Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
The potential impact of hospital closures on healthcare access continues to raise concern among policymakers, as evidenced by the newly authorized New York Hospital Closure Planning Act (which requires state health officials to hold public forums and provide information about alternative healthcare resources following hospital closures). The objectives of this study were to 1) identify the overall population affected by hospital closures and 2) identify racial/ethnic differences in enabling resources among affected populations. The study utilized Medical Expenditure Panel Survey data from 1996-2003 and community-level data collected from a number of sources, aggregated using FIPS county codes. Data were survey-weighted and cross-tabulated to identify relationships between variables. Overall, approximately 9.3% of the U.S. population lived in counties with closures from 1996-2003 (affected population). Compared to whites, higher proportions of racial/ethnic minorities were affected by hospital closures (whites: 6.9%; blacks: 12.1%; Asians/NHPIs: 13.9%; Mexican-origin Hispanics: 20.7%; other Hispanics: 14.0%). Among affected populations: less Mexican-origin (58.3%) and other Hispanics (59.7%) reported having a usual source of care (USOC), compared to 70.6% overall; more blacks (29.8%), Mexican-origin (29.3%) and other Hispanic (24.6%) reported that their USOC was a hospital, compared to 20.8% overall; more blacks (20.0%) and other Hispanics (19.1%) reported using public transportation or walking to their USOC, compared to 9.4% overall; more Mexican-origin (47.2%) and other Hispanics (40.0%) were uninsured or discontinuously insured, compared to 27.9% overall. These findings suggest that, compared to whites, racial/ethnic minorities are more dependent upon hospitals and may have more difficulty accessing healthcare following hospital closures.

Learning Areas:
Provision of health care to the public
Public health administration or related administration
Public health or related public policy

Learning Objectives:
1. Identify overall and racial/ethnic populations affected by hospital closures 2. Compare overall and racial/ethnic differences in enabling resources in populations affected by hospital closures 3. Discuss initiatives to be considered by community providers and other stakeholders to prevent further widening of racial/ethnic disparities in healthcare access in the wake of hospital closures

Keywords: Access to Care, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Kellogg Health Scholar Postdoctoral Fellow in the Center for Research on Minority Health in the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center. I recently completed a Ph.D. in health services research with specialization in health policy at UCLA. My dissertation examined whether hospital closures differentially impact access to care for racial/ethnic minorities, compared to non-minorities. Previously, I earned a Master of Business Administration (MBA) and Master of Science in Health Administration (MSHA), with concentrations in marketing, finance and management, and a Bachelor of Arts (BA) in mass communications. Additionally, I am a Fellow in the American College of Healthcare Executives, which signifies that I am board certified in healthcare management. I have nearly 10 years of experience in healthcare management, marketing and business development - primarily developing and implementing communication and outreach initiatives targeted to diverse patient and physician populations while working in the hospital industry - and several years of experience as a journalist. My research interests include the role of perceived and actual bias, stereotyping and discrimination on healthcare behaviors, access and outcomes; the effect of insurance status, type and continuity on healthcare access and quality among vulnerable populations; and research and policy development in the area of community contextual factors, with an emphasis on exploring the role of public-private partnerships in improving access and quality for vulnerable populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Access to Care II
See more of: Health Administration