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Emergency Room Closures Hit Minorities, Poor Hardest

While some ERs in California thrive, others are feeling financial pressure.
Jason Redmond
While some ERs in California thrive, others are feeling financial pressure.

Patients in California may find a shuttered glass door the next time they seek out emergency care, as hospitals across the state close emergency rooms.

California hospitals that serve large numbers of blacks and Medicaid patients, who often rely on ERs the most, run a higher risk of closing the emergency department, according to an analysis just published in the Annals of Emergency Medicine.

Financial factors, such as how much the hospital relies on Medicaid payments, contribute to the shutdowns, says Dr. Renee Hsia, study author and assistant professor of emergency medicine at University of California, San Francisco.

Using data from 1998 to 2008 — a period when 7 percent of the Golden State's emergency departments closed — researchers found that for every 10 percent increase in black patients, a hospital's risk of shutting down its ER shot up by 40 percent. For every 10 percent increase in Medicaid patients, the risk jumped up by 17 percent.

Similar results were not seen with Hispanic patients, a population that has traditionally been considered vulnerable as well.

"In many places, the emergency room is where most patients first come through to get care," Hsia tells Shots. "If you close that department, you close the door to those patients."

Areas with poorly insured residents have fewer emergency departments. More affluent areas, plentiful with privately insured patients, have hospitals that are more likely to add emergency departments.

She says the closures affect everyone, though. "Even if your ER doesn't close, those people who need services will come to yours," she says. "The increased pressure on the remaining ERs will fuel the overcrowding we're experiencing."

Another problem: patients who have to travel farther for emergency care tend to have worse treatment outcomes.

ER closures aren't limited to California. Another recent study by Hsia found a 27 percent decline in nonrural emergency departments across the country from 1990 to 2009.

Even as ERs disappear, the need for emergency care is growing, Hsia says: "It's important for people to understand that there will be an increase in demand for emergency care."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Kristofor Husted is a senior reporter at KBIA in Columbia, Mo. Previously Husted reported for NPR’s Science Desk in Washington and Harvest Public Media. Husted was a 2013 fellow with the Institute for Journalism and Natural Resources and a 2015 fellow for the Institute for Journalism and Justice. He’s won regional and national Edward R. Murrow, PRNDI and Sigma Delta Chi awards. Husted also is an instructor at the Missouri School of Journalism. He received a B.S. in cell biology from UC Davis and an M.S. in journalism from Northwestern University.
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