This decline of hospital beds comes just at the time when the population usually in need of hospital care (baby boomers) is peaking. And New York is not alone, as many cities face hospitals in crisis and their own wave of closures, though it seems that NYC just might be leading the pack. Therefore what we do here and now, might have larger, national implications. Doing nothing should not be an option.
The causes are many, from poor management and corruption to declining reimbursements from government and insurance companies to an increasing percentage of uninsured. Clearly, it seems to be a perfect healthcare storm.
On October 1, portions of the Affordable Care Act further reduced reimbursement levels for hospitals, which might just set off yet another wave of closures and mergers. Just recently two large healthcare systems in Gotham announced they intend to merge, which might actually increase healthcare costs and drive smaller, independent hospitals further into crisis.
In the U.S., healthcare is a business, a big one. So, decisions to close or remain open are purely based on the bottom line. States and municipalities are increasingly unlikely to step in to bridge struggling institutions with either seed money of support. So, every healthcare system is on their own. In New York, we have ourselves a healthcare system that seems to replicate big box retail, with a few large chains dominating the market.
We also have been warned that New York City, amidst the wave of closures and mergers, faces a critical shortage of hospital beds that will, at some near point, affect the city’s public health. Yet, we do nothing about it.
Those who bemoan the crisis are ignored or seen as currying political favor. Mayoral candidate Bill de Blasio, a Brooklyn resident who has gone so far as getting arrested to protest a recent hospital closure, issued a report as public advocate.
The report finds that the proposed closing of two Brooklyn hospitals, Long Island College (part of the State University of New York system) and Interfaith hospitals, would greatly impact vulnerable communities that live in the surrounding areas. It would increase ambulance travel times as much as 10 minutes per call, and put increased pressure on the few remaining borough hospitals.
There is clearly a political incentive for de Blasio to issue this report, but as public advocate it is also his job. And, beyond these two hospitals, others are in a precarious position. Wyckoff Heights Medical Center, also in Brooklyn, only has 30 days of cash on hand and has already experienced a wave of staff reductions and is in Chapter 11 bankruptcy. Is it next to go?
There is an impact on the lives of New Yorkers, however. When St. Vincent’s Hospital closed in 2010, it left a void in the community of the West Village. Continuum Health Partners stepped in, but not with a hospital.
Continuum built a network of outpatient clinics that from a business perspective was smart because it drives traffic to its hospitals out of the neighborhood. Yet, can a series of urgent care centers or Duane Reades actually fill the void of a hospital?
What’s to be done? Well, a writer in the Brooklyn Eagle suggested, tongue-in-cheek, that we simply let the Upper East Side become the Hospital District, complete with themed restaurants. As that author knows, healthcare isn’t a joke because lives are at stake, but this seems to be what is happening. Concentrations in healthcare delivery have created healthcare deserts and oases. If you are fortunate enough to live in the right neighborhood, you will be okay.
This has significance for urban development. Residents who are thinking about moving to newly “discovered” (read gentrifying) neighborhoods might rethink their choices in the light of these closures. We know that the so-called “creatives” crave culture, but they just might require medical care, too.
By letting our healthcare system die, New York is hurting itself. There was a time, not long ago, when cities and states felt a responsibility for the health and well-being of its citizens. We might teach this civics lesson in school, but we certainly don’t act out its values.
Richard Greenwald is a professor and Dean at St. Joseph’s College, NY. He is the author of the forthcoming The Death of 9-5: Permanent Freelancers, Empty Offices and the New Way America Works.