Blacks and Medicaid Patients at Higher Risk of Losing Their ERs in California

WASHINGTON, Nov. 16, 2011 /PRNewswire-USNewswire/ -- For-profit hospitals and hospitals serving black and Medicaid patients were at higher risk of closing their emergency departments in California, which the authors of a study published online today in Annals of Emergency Medicine say has the potential to magnify health disparities in vulnerable populations ("System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients Are at Higher Risk of Losing Their EDs"). 


"We have a very market-driven approach to health care, and financial factors often dictate the availability of health services, even the so-called 'safety net' of emergency care," said study author Renee Hsia, M.D., MSc, of the University of California, San Francisco.  "ER closures affect the whole community, not just the immediate neighborhood, because these losses increase the pressure on remaining ERs to provide more services to a larger number of patients.  And patients have to travel farther for care, which has been associated with poor patient outcomes."

Researchers analyzed California hospital data from 1998 to 2008, a period during which 7.2 percent of emergency departments in the state closed. For-profit hospitals had 65 percent higher odds of closing than non-profit hospitals.  For every 10-percent increase in black patients a hospital served, the odds of its ER closing increased by 40 percent.  For every 10-percent increase in Medicaid patients a hospital served, the odds of its ER closing increased by 17 percent.  Similar results were not seen with Hispanic patients, a population that has traditionally been considered vulnerable as well.

Fewer emergency departments were located in areas with poorly insured residents and hospitals were more likely to add emergency department capacity in suburban markets serving patients with private insurance.

"Emergency department closures disproportionately affect vulnerable populations, but there are system-wide ripple effects felt everywhere," said Dr. Hsia.  "Future research on emergency department closures must examine their impact on health outcomes.  It is concerning that the very populations who most rely on emergency services may experience declines in access to emergency care."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit

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SOURCE American College of Emergency Physicians (ACEP)