Non-profits leaving poor neighborhoods

In theory, the underserved inner city is the ideal place to locate a major campus of a non-profit hospitals. After all, it is their mission to help the poor and uninsured get better access to care, and what's more, doing so is the basis for their tax exemption. However, they too have bills to pay, and inner-city case loads just aren't proving sustainable for many. In fact, a growing number of non-profits are closing urban campuses in favor of focusing on suburban hospitals with more prosperous clientèle, while others are refurbishing hospitals in more affluent locations where patients have private insurance.

The non-profits making these moves defend their activities, saying that they have to build high-income locations to pay for the losses they take in poorer communities. For example, that's the position taken by Ascension Health, the country's biggest non-profit system, which recently closed its third Detroit-based hospital while planning a $224 million facility in one of the city's wealthy suburbs. Meanwhile, execs note that Riverview hospital, its recently-closed facility, was largely seeing insured patients through its emergency room, for non-emergency care--and suggested that what its neighborhood needs is more primary care doctors.

Critics, however, note that without Riverview, the neighborhood has deteriorated, discouraging additional doctors from coming there. What's more, the urgent care center that replaced Riverview is not required to see the poor; all comers without insurance must pay a $50 deposit to get care, they say.

To learn more about this trend:
- read this Wall Street Journal piece