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OPINION: Address community needs before closing hospitals

Long Island College Hospital in Cobble Hill, threatened with closure by SUNY Downstate.

N.Y. Lawyers for the Public Interest

The need to reduce healthcare costs and insure the uninsured has led to a most important and massive undertaking of healthcare reform, the Affordable Care Act. However, for years, and with little public notice, another means of reducing healthcare costs has had devastating impacts on communities of color and those that are low-income. 

To reduce costs, many safety-net hospitals are being completely closed, merged with other hospitals, or facing a reduction in beds. Safety-net hospitals fulfill otherwise unmet healthcare needs in a community, where under-served populations simply go without care. Often, these drastic changes to care delivery take place without consideration for the health and safety needs of the impacted neighborhoods. Their challenges accessing quality healthcare will only be exacerbated unless hospitals and policymakers listen to these communities and put their needs first.

To better understand the neighborhoods that face the brunt of these closures and restructures, just look at North and Central Brooklyn. Many residents live in impoverished, highly segregated neighborhoods, and are uninsured or rely on public insurance. They lack access to quality medical treatment and often face long waits, travel farther for care, and go to emergency rooms for non-emergencies because less costly treatment facilities are not available.

Providers serving these vulnerable populations often face financial challenges since they don’t have adequate resources to address all of their needs.  These populations simply cannot afford to get sick, and the long-term result is that people are living sicker and dying younger.
 
Unfortunately, the radical restructuring of care has occurred without an adequate understanding of such communities’ needs. Nonetheless, policy makers and hospitals can begin to address the disappearance of safety-net hospitals by listening to communities directly and gathering critical data about barriers and gaps in care from the perspectives of those who utilize it.

New York Lawyers for the Public Interest, Brooklyn Perinatal Network, and the Commission on the Public Health System recently conducted a Community Health Needs Assessment (CHNA) in Brooklyn to inform changes to the health delivery system and provide better health care. One insight from the CHNA was that many patients who visited the emergency room in the past two years went for treatment of heart disease or asthma, though both can be treated in outpatient settings.

Thus, our recommendations include focused attention on specific illnesses with high rates in certain areas of Brooklyn so that hospitals can provide efficient and less costly care rather than closing and not providing any care.

Solutions such as CHNAs and the resulting healthcare planning are critical because the phenomena of closure and restructuring reflects a much larger crisis that has been in operation for years and will continue to impact neighborhoods far beyond North and Central Brooklyn.  An accelerated process of closing hospitals in New York goes back as far as 1976, and in the past 10 years, 15 hospitals across New York City have closed. Just last year, Peninsula Hospital Center in Queens closed, and in recent weeks, the Board of Trustees of the State University of New York voted to close Long Island College Hospital.
 
Unless policymakers and hospitals address communities’ needs, rather than blindly continuing the process of closure and restructuring, access to quality healthcare will be nonexistent for communities in desperate need of care.

Shena Elrington is the director of the Health Justice Program at New York Lawyers for the Public Interest and Jennifer Swayne is a staff attorney.

April 22, 2013 - 8:15am


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