Hospital Viability and Closures

Abstract

����� During the last several years, the debate over hospital closures continues to plague those concerned with assuring adequate medical care for the underserved, even as little concrete evidence is available about the impact of hospital closures on access to and outcome of medical care. The emphasis we place upon hospitals in contributing to human well-being is natural; hospitals are great temples of mysticism. The two greatest human events in life occur there—birth and death. This reality alone gives hospitals tremendous societal power and responsibility. During the past decade, demands and needs increased for hospitals to render primary care to the poor and uninsured. But over time, the hospital's role in providing primary care to low-income populations has become too exclusive in many communities. The fact that hospital closures have received so much professional interest and are so important to low-income populations reflects a great distortion of misplaced attention. Hospital closures are distressing symptoms of a health care delivery disease that is causing widespread debilitation in the provision of health services. My vision is that there are three phases of health care development: 1. Anarchy—the era of cottage industries, which are unsystematic and highly individualistic; 2. Competition—the era of adolescence, characterized by duplication, waste, elaborate resources, and tremendous inequities; 3. Collaboration—a period when continued limitation and reduction in resources creates a great equalizer and forces providers of health, education, social, and other human services to work together. This new combination of skills and idea will produce significant progress. When will this era of collaboration begin? After the 1990s. The 1990s will be a decade of destruction and disassembling of the current system. Signs and indicators already point in that direction. Our health care delivery system represents vast waste that we as a society can no longer afford. It makes no sense