Hospital closure in urban and rural areas and patients’ welfare

Abstract

The hospital sector is frequently subject to reconfigurations, with some departments closing and new ones opening. Using a conditional logit model based on observed patient choices, we quantify the effects of a hospital department closure on the welfare of elective hip replacement patients in England. We simulate eight separate closures of the provider with lowest quality, as measured by one of four quality measures: revisions, emergency readmissions, 30-day mortality, change in the Oxford Hip Score, in urban and rural areas. The average reduction in welfare for patients who attended the closed hospital is equivalent to having to travel between two and ten additional kilometres for treatment, compared to their average travel distance, pre-closure, of 17.4 kilometres. The reduction in patient welfare is generally more pronounced when closing a hospital in a rural area (about 50% higher when quality is measured by the Oxford Hip Score and emergency readmissions).