Shrinking Medical Options

As a nurse, I love (sic) to hear how America has the best medical care available of any country. So let me correct this statement for you. We have the best medical care available to those who can afford it and live in the right areas or have the luxury of being able to travel long distances to access that care.

The distance issue is becoming an increasingly alarming issue. For years, hospitals have been closing at a rate of 30 hospitals per year across the US. At first glance, this number doesn’t sound horrible. However, then we have to dive deeper into those numbers.

According to the American Hospital Association (AHA), as of 2016, there were only 5534 hospitals operating in the US. Of those,

209 are federal government hospitals.

397 are non-federal psychiatric hospitals.

88 are counted as “other” hospitals.

All those can be removed from the total serving communities, bringing the number down to 4840. Of that number, only 1825 are rural hospitals. Yet rural hospitals and those in low income areas are the ones closing at the fastest rate.

As stated, these numbers are from 2016, so the number of active facilities are even lower as of this time.

Even worse? Included in that 4840 number are rehabilitation and chronic care hospitals. There are no accurate numbers available, so there is no way of knowing how many of the 4840 are not acute care facilities. I have worked at various rehabilitation facilities that call themselves hospitals and even then objected to that designation. People seeking emergency care will not find it available at those facilities.

To be considered a hospital only requires that a facility maintain six inpatient beds.

Total hospital admissions for 2016 totaled 35,158,934. So that equals 6353 hospital admissions per facility. An admission can be for one day or 6 months. An admission only counts one time for each facility, so that has no correlation to how many hospital days are spent on each admission.

In 2016, there were a total of 894,574 beds to accept those admissions, meaning there were 39 admissions for each hospital bed in this country.

The average cost of one hospital admission was $28,201.

So, in the country that pays the absolute highest amount for medical care of any country on earth, we are seeing a reduction in the number of hospitals and hospital beds, leaving the poor and rural in situations with even less care than they had to begin with. This coming even as the cost of insurance skyrockets yet deductibles climb ever higher.

The rate of hospital closures is expected to accelerate even faster in the near future.

To illustrate the difference over time, consider the fact that in 1975, there were 7156 hospitals in this country. Now we have 5534, which is a loss of 1622 hospitals. The population of the US in 1975 was 216 million. while in 2016 the population was 323.4 million.

As the population increases while the number of hospitals continues to decrease, this situation becomes ever more critical. The loss of hospitals also means loss of tens of thousands of living wage jobs in our communities, causing ever worsening effects on the economy.

Even now, hundreds of thousands of Americans living in rural communities must make drives or be transported hundreds of miles to access inpatient medical care while being far from family and friends, leading to more negative medical outcomes. Meanwhile those in less affluent areas suffer more obstructions to care.

I do understand that some will offer a counter-argument that hospital stays today are shorter. That is true but is more than offset by the fact that more medical procedures are performed outpatient than ever. In some cases, that’s fine, when consequences are not likely to be life threatening. When we talk about invasive or cardiac procedures, that’s a different story. Yet it happens daily. Patients are being discharged the same day as elective heart catheterizations and gall bladder surgeries, each of which should mandate at least overnight observation. Why is this happening? Simple, save the hospital beds for those with the insurance that pays more. The fact that any insurance plan would approve these circumstances tells you they are more concerned with paying a hospital than quality of care. It really is that simple.

Yes, modern medical procedures are less invasive than they were decades ago, meaning shorter recovery times on average. No sane medical professional advocates for more invasive procedures or hospital stays longer than necessary for safety. Each of those carry their own consequences, including hospital-acquired infections and blood clots (DVT). The longer you are hospitalized, the higher the risk. Yet even rehabilitation is often cut shorter than it should be based on insurance payments as opposed to patient needs.

We are already past the tipping point on medical safety as a nation. One epidemic or catastrophe means the medical systems we have in place are overwhelmed easily. The average age is rising, increasing your chances of needing hospital care at some point. Will it even be available if or when you need it? In the face of a decades-long nursing shortage, nurse pay is static or even declining locally. Experienced nurses and doctors are leaving the profession due to stress. That leaves less experienced, more apathetic people in their place that consider medicine “just a job”.

Life expectancy in the US is actually declining, alone among all developed nations. While medical advances and best practice is extending care in other countries.

There is no scenario where we can consider our medical system to be the best available under these conditions. I would love to say this cannot continue but at the moment I fully expect it to continue unabated until it becomes critical. For many, it already has but those voices are not heard by Wall Street, corporate media and bought politicians.

The question is, are you listening?

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