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Impact on Patients' Access to Care and Health Status

Andrew B. Bindman, MD; Dennis Keane, MPH; Nicole Lurie, MD, MSPH

JAMA. 1990;264(22):2899-2904.

Abstract
We studied the impact of the closing of a public hospital on patients' access to care and health status. We surveyed individuals who had been medical inaptients at Shasta General Hospital, Redding, Calif, in the year prior to its closing and compared them with those in a second county, San Luis Obispo, whose public hospital did not close. Surveys were administered after the closing of Shasta General Hospital and 1 year later. We assessed outcomes using the Medical Outcomes Study Short Form and a series of transition questions that asked about changes in health over time. Data were available for 88% of patients at 1 year: 219 from Shasta County and 195 from San Luis Obispo County. At follow-up, the percentage of patients from Shasta County who reported no regular provider increased from 14.0 to 27.7 and the percentage who reported they were denied care rose from 10.8 to 16.9. Meanwhile, patients in San Luis Obispo County reported improved access to a regular provider and the level of denied care was unchanged. Patients in Shasta County had significant declines on the Medical Outcomes Study Short Form in health perception, social and role function, and increases in pain as compared with those patients in San Luis Obispo County. The closing of a public hospital had a significant effect on access to health care and was associated with a decline in health status.

(JAMA. 1990;264:2899-2904)

Author Affiliations
From the Department of Medicine, San Francisco General Hospital and the Institute for Health Policy Studies, University of California, San Francisco (Dr Bindman and Mr Keane) and the Department of Medicine, Hennepin County Medical Center and the University of Minnesota School of Medicine and the Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis (Dr Lurie).; Dr Bindman was a Robert Wood Johnson Clinical Scholar at Stanford (Calif) University when he performed this work. Dr Lurie is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Footnotes
The views expressed herein are solely those of the authors and do not necessarily reflect those of the Veterans Administration, the Robert Wood Johnson Clinical Scholars Program, the Sierra Foundation, or the James Irvine Foundation.

Reprint requests to Department of Medicine, San Francisco General Hospital, 1001 Potrero Ave, Room 5H-22, San Francisco, CA 94110 (Dr Bindman).

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