Posted on 06/10/2007 11:26:49 AM PDT by libertarianPA
DETROIT - Her legs crippled by diabetes, Mary Lewis is grateful it's a short distance between her doctor's office at Riverview Hospital and the adjacent apartment tower where she lives.
It will become a painful struggle next year when the hospital closes and physicians' offices are forced to move. The hospital last week said it was losing too much money and already stopped accepting inpatients, though the emergency room will remain open for now.
Because roughly 90 percent of its 11,000 annual inpatients are covered under the Medicare or Medicaid public assistance programs, Riverview has struggled economically, said Bob Hoban, a senior vice president for St. John Health, Riverview's parent company.
Experts say Riverview's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved.
Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers.
"This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."
New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation.
But few cities have been hit as hard as Detroit.
The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.
Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998.
"Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."
Riverview, a community hospital with 285 beds, specializes in general medical and surgical services, such as treatment of congestive heart failure, diabetes and obstetrics.
The hospital finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red.
Medicare payments to hospitals averaged 92 cents for every dollar spent providing care in 2005, the most recent figures available, according to the American Hospital Association. Medicaid's reimbursement rate was lower, at 87 cents per dollar.
Officials at other area hospitals have complained that Riverview's closing will burden them.
"We're 90 percent full on average and there are many days where we're 100 percent full," said Nancy Schlichting, president and chief executive of Henry Ford Health System, which has a trauma center hospital in Detroit.
Karmanos Cancer Institute plans to spend $20 million to renovate the 20-year-old Riverview and reopen it as a clinical center next year.
But Lewis is concerned her doctor's office will be forced to move too far from her home. "I'll have to find another doctor," the senior citizen said.
While waiting for a bus after a physical therapy appointment, Mary Sanders said Riverview is the closest hospital for residents of the east side, including many disabled senior citizens.
The 54-year resident of the neighborhood said she doesn't know where she'll go once the clinic closes.
"Point blank, we need this hospital," she said.
It costs money to treat gunshot wounds and such.
Actually they should close Detroit St. Louis, Philadelphia and Cleveland.
What was the population of Detriot in 1960?
What is it now?
hospitals.....farmers....auto companies...if you are so poor at running a business, then you deserve to go out of business....
The pattern of delivery of health and medical services to consumers (patients) will alter tremendously over the next decade.
Already there are walk-in clinics in Wal-Marts, and urgent-treatment centers that are free-standing apart from hospitals, where what once would have been an emergency-room visit, is now treated as a walk-in. These places are usually not recognized by insurance companies and certainly not by Medicare-Medicaid, because they are on a cash basis (or credit card), giving the urgent care, and sending you back to your personal physican with their recommendations, but their relationship pretty much ends when you leave the premises.
What this amounts to, is the availability of care based on the ability to pay, a most personally responsible manner at which to look at delivery of medical services.
Sure, this urgent care costs a lot when it is called upon. Emergency room care costs a lot too, but this way, the care is rationed only dependent upon your ability to pay. The thing is, they will look at you without sending you through triage first.
After all, what is your time worth?
Crime and obesity/diabetes. Those two do it. Diabetics have some of the most uncooperative wounds, the longest healing times, the most complications—not to mention a high rate of other problems. Given the high inicidence of it in blacks and how prone to violence that community is and the minute emphasis on education, well, this is what you get.
I’m in Memphis it’s what you see here. At least three shootings last night. No one wears a seatbelt. Few pay for their care. Almost all are obese or gangsters. Sad state of affairs.
It was nearly 2 million in ‘50-’60, and is down to below 900k today. Ain’t communism grand ?
The latest estimate I could find was 835k.
Yet they have no clue...
Not true. In Phoenix nearly every hospital is near insolvency because they are required by law to supply free healthcare to illegals.
I agree and many use the taxi-cab service called EMT.
Census estimate for 2005 was 887k, down 65k since 2000 (and I wouldn’t be surprised if those numbers were padded). It’s amazing it hasn’t plummetted to the degree some were estimating (with a levelling off at around maybe 300k by 2030 or so). It’s not just that Detroit lost so many people, but that it lost virtually all its Whites and the Black middle class. Detroit was a majority-White (and Republican !) city until a few decades ago. Hard to believe it ever was.
As a Detroiter who has recently moved to Philly, I must they don’t belong in the same breath. Philly is a huge improvement over Detroit.
As a Detroiter who has recently moved to Philly, I must they don’t belong in the same breath. Philly is a huge improvement over Detroit.
Hey, I have a question - last time I was in Detroit, there was a raodsign that said “Police Entrapment Zone”
What in heavens does that mean?
true, i stand corrected on these points...however, the feds do pay farmers not to grow crops...and the only broke farmers i know are ones with IQ’s below 6.........
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