April 15 2020
“The Song of the Nibelungs” leitmotif is the idea that after happiness comes pain.
Q: Why is there a shortage of hospital beds?
A: The healthcare “reform” is an endless source of argument between governments, healthcare administrators, doctors and public around the world. Despite bitter disagreements, the leitmotif of all reforms is “efficiency”, which means cost reduction in plain English.
There are multiple ways to achieve cost reduction in healthcare:
Cut prices/insurance reimbursements paid to doctors and other providers by arbitrary goverment decisions or by aggressive contract negotiations;
Penalizing providers for readmissions;
Reduce number of people employed in healthcare, starting with physicians;
Reduce physician and other medical staff pay;
Pass some of the risk or even entire risk to providers based on capitation system, when provider receives fixed amount per each patient enrolled into their practice regardless of actual utilization of services;
Shorten hospital stays;
Reduce hospital stays by transferring care to outpatient facilities, such as surgical centers;
Decrease number of hospital beds;
Close hospitals altogether.
Cost reduction brings “happiness” to the government, insurers, employers and other payers. Then comes the pain: shortage of hospital beds, overcrowding of emergency rooms, lack of equipment (think ventilators), longer wait for essential care, and poor outcomes.
Q: How many hospital closures are we talking about?
A: Here is the USA statistics for the last 5 years:
28 closures in 2015
21 closures in 2016
16 closures in 2017
23 closures in 2018
47 closures in 2019
Q: How many hospital beds were lost?
A: There are 534,000 fewer hospital beds in the USA now than in 1975.
Q: What is the total number of beds in the USA?
A: American Hospital Association (AHA) reported:
931,203 beds in 2017 (the latest year with available data)
1,213,327 beds in 1990
1,465,828 beds in 1975
Q: What about New York?
A: Since 2003, New York has seen 41 hospitals closed statewide, including 18 in New York City alone. The patients at these hospitals that are being closed tend to be uninsured, tend to be racial and ethnic minorities, and undocumented.
The Empire State had 73,931 licensed hospital beds in 2000 before years of cuts and closures shrank the number to just 53,000 in 2020.
ICU beds in the state hasn’t budged in 20 years — there were 3,043 intensive care spots in 2000; currently, there are 3,000.
Here is the list of notable hospitals in NYC that have closed in the last 20 years:
Goldwater Hospital was opened in 1939 as a “monument to the golden years of public health in New York City.” The hospital was demolished in early 2014. At the time of its de-commissioning, Goldwater housed a nursing home and a hospital specializing in respiratory and rehabilitative medicine;
Saint Vincent Catholic Medical Center (SVCMC) in Greenwich Village was a major teaching hospital that was founded in 1849 and served a wide range of New Yorkers until its closure on April 30, 2010. SVCMC opened during New York’s cholera epidemic, and a typhoid epidemic in 1852 filled the hospital to capacity once again. The hospital filed for bankruptcy in 2005, and leading up to its closing, the New York Department of Health announced that there would be no need for an acute care hospital like SVCMC in Greenwich Village. After struggling for the decade to keep the hospital open, its emergency room closed in 2010;
Long Island College Hospital (The University Hospital of Brooklyn at Long Island College Hospital) was founded as the Long Island College Hospital in 1858, was a 506-bed teaching hospital in Brooklyn that closed on August 30, 2014. The hospital pioneered major advancements in the medical field such as bedside teaching. It became one of the first hospitals in the United States to use anesthesia and stethoscopes, and in 1873, it introduced the first emergency ambulance service in Brooklyn;
Triboro Hospital for Tuberculosis in Jamaica, Queens, operated as a tuberculosis sanatorium and later a general hospital from 1941 until the early 2000s. The New York City Council approved plans in 2018 to renovate Triboro Hospital for affordable housing, and the hospital was added to the National Register of Historic Places in 2019;
Neponsit Beach Hospital located in Rockaway, Queens is a former tuberculosis sanatorium adjacent to Jacob Riis Park that opened in 1915. The hospital closed in 1955 once the tuberculosis epidemic began to slow down, and it later operated as the Neponsit Health Care Center until 1998;
Seaview Hospital opened its doors in 1913. Like many tuberculosis hospitals in the 20th century, the grounds and buildings were designed with an “open air” concept in correlation with the popular belief that fresh air and sunlight were the best cures for infectious diseases. At one point in time, the hospital served as the largest tuberculosis sanitarium in the country. It is also the location where the cure for tuberculosis was discovered.
Today, the Seaview Hospital site is partially occupied, having been renovated and repurposed by NYC Health + Hospitals. It is also in line to be further renovated as a mixed-used, health and wellness-focused development;
North General Hospital (NGH) was a private, not-for-profit teaching hospital in East Harlem that closed in 2010. Opened in 1979 to replace, as tenant, the Hospital for Joint Diseases, NGH had a significant impact on East Harlem’s economy, acting as the largest private employer in Harlem. It was the only minority-run, voluntary teaching hospital in all of New York state.
NGH opened as the Joint Diseases North General Hospital at its first East Harlem location, but the hospital moved in 1991 into a newly built facility two blocks south. Yet, by 2004, private hospitals in New York, including NGH, were behind by more than $100 million in payments to pension funds and employee benefits. By its closing, the hospital had a debt of around $293 million, closing four days after Saint Vincent’s Hospital. The hospital, a symbol of Harlem’s growth, closed with little warning, leaving many patients frazzled;
The Cabrini Medical Center in Gramercy, Manhattan was created in 1973 through the merging of two Manhattan hospitals: Columbus Hospital and Italian Hospital. The hospital was closed in 2008 after filing for bankruptcy.
Founded in 1892, Columbus Hospital officially opened in 1896 by the Missionary Sisters of the Sacred Heart of Jesus, founded by the merger hospital’s namesake Mother Frances Xavier Cabrini. The hospital had a capacity of around 100 beds and was created to address the medical needs of Italian immigrants. The Italian Hospital was created four decades later in 1937 by the Italian Hospital Society, which served a similar purpose. The two hospitals merged in 1973 into a nearly 500-bed facility and became one of the first hospitals to expertly treat patients with AIDS.
The Cabrini Medical Center closed permanently on March 16, 2008 after previously announcing that the Emergency Department would be closed. Memorial Sloan-Kettering Cancer Center purchased the medical center buildings for $83.1 million, but they were later converted into residences in 2013;
Bayley Seton Hospital, in Staten Island’s Stapleton neighborhood, began as the Marine Hospital Service in 1831. The hospital was turned over to Saint Vincent’s Medical Catholic Center in 2000, which filed for bankruptcy in 2003 and soon after closed.
In what was known as the Staten Island Quarantine War , mobs burned down the nearby New York Marine Hospital in 1858. On the top floor of the Marine Hospital, a man named Dr. Joseph J. Kinyoun established a laboratory to study bacteria, and after this laboratory moved to Washington D.C. with the help of Congress, it became the National Institutes of Health.
Q: Which segments of the population are the most affected by these closures?
A: Minorities and poor. The main reason for hospital closures in NY and elsewhere is financial insolvency, in part triggered by vast numbers of uninsured and poor population using hospital as their safety net but unable to pay. With the government looking other way, hospitals are on the mercy of charities, but those can hardly afford to pick up the tab with dwindling reimbursement and increasing regulations and administrative burden.
The result:
Black people account for 17% of coronavirus deaths in New York, excluding New York City, but only 9% of the population;
In New York City more Hispanics per capita are succumbing to the illness than any other ethnic group;
In Michigan, African Americans account for 14% of the state's population but 33% of COVID-19 cases and 40% of deaths;
In Chicago, 72% of the deaths have been among the city’s black residents, though they make up 29% of the population;
In Los Angeles County, 17% of the deaths were among African Americans, though they make up only 9% of the county’s population.