地域の病院を閉鎖の危機が襲う/米国医療事情

地域の病院を閉鎖の危機が襲う
 地域といっても貧困層の多い地域で大きな問題となっている。以前にとりあげたロスの病院閉鎖の話題も絡んでいる。
ロサンゼルス公立病院の閉鎖/米国医療事情
http://kurie.at.webry.info/200708/article_21.html
 病院管理者や専門家、州のデータによれば、ロサンゼルスとオレンジ郡の15%以上の病床を占める20以上の病院が、資金面で窮地に陥り破産や閉鎖の危機にある。この問題は保健医療システムの深刻な負担を担わされていた地域のクリニックや病院が閉鎖されたために生じてきた。さらにいくつかの病院が閉鎖したり、お金のかかる集中治療サービスを閉鎖したりすれば、特に貧困層や無保険者にとって、長時間の救急車乗車や、ERの更なる待ち時間延長、医療アクセスの悪化を招くだろう。2つの病院はERの閉鎖(うち1つは、早ければ来年)を考えている。危ない病院には以下の病院が含まれる。 Downey Regional Medical Center, Centinela Freeman Health System in Inglewood, Brotman Medical Center in Culver City, Century City Doctors Hospital and four Orange County hospitals owned by Santa Ana-based Integrated Healthcare Holdings Inc. including Chapman Medical Center in Orange and Western Medical Center in Santa Ana, one of three trauma centers in the county. 財政の問題は多くの要因が絡んでいる。
*無保険患者と低所得患者の増大による負荷は、公的施設の混雑と閉鎖が原因。特にロサンゼルス郡の貧困地域で無保険の患者が私立病院にかかる割合が02年から1/3増加した。貧困層向けのカリフォルニアのMedi-Calプログラムでは、病院への補償は郡の最も低い率で払い戻される。
*先月Willowbrookのマーチン・ルーサー・キングJr.港湾病院の閉鎖により、年間47000人にのぼる公的病院ER受診者が近隣の5-6カ所の病院に殺到した。
*数少ない大病院がより多くの医師と有保険患者を集めるにつれ、より小さな地域の病院に行く患者は減少する。
*保険会社は近年共謀して(合併して?)多くの小さな施設の締め上げをし始めた。大きな病院ほど保険会社との交渉力が強く、従って支払率も高くなる。
*新たなより厳格な介護要員比率の州命令により人件費が高騰し、さらに2013年に迫った耐震基準の期限にあわせ医療設備にかかる費用は州全体で1100億ドルと見積もられている。
 影響は既に患者に及んでいる。ある病院では、効率化のための対策をとったにも関わらず、ERでの待ち時間は平均で 11.5時間になってしまった。財政危機と共に、持てるものと持たざるものとの差は開く一方である。巨大で有名な病院が利益と病床を増やす一方で、より貧しい地域の小さな病院は毎年数千万ドル以上の赤字を出している。Tenet社のようなコングロマリットが急速に撤退したため、多くの地元の病院が独立経営となり、財政的な余裕がなくなった。96年以来、州内の70以上の地域の病院が閉鎖したが、そのうち南カリフォルニアが50以上を占め偏っている。この地域では最近5年間で14カ所のERが閉鎖したが、そのうちロサンゼルス郡が10カ所を占める。
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Financial woes jeopardize area hospitals
http://www.latimes.com/news/local/la-fi-hospitals23sep23,0,1253335.story?coll=la-home-center
Nearly two dozen are at risk. Losing even a few would mean greater strain on the region's healthcare network.
By Daniel Costello and Susannah Rosenblatt, Los Angeles Times Staff Writers
September 23, 2007
画像Filling a need
Luis Sinco / LAT
Mike O’Dell of St. Francis Medical Center said his hospital has experienced a one-third increase in ambulance arrivals in the last month.

Nearly two dozen private hospitals in Los Angeles and Orange counties, accounting for up to 15% of beds in the region, are in dire financial straits and in danger of bankruptcy or closure, according to hospital administrators, industry experts and state data.

The troublesome development follows the closure of community clinics and hospitals in recent years that has left the healthcare system seriously overburdened.

If even a few other hospitals close or reduce costly critical-care services, it could mean longer ambulance rides to hospitals, additional delays in emergency rooms and less access to care, especially for poor and uninsured people.

Among the hospitals in poor financial health, according to industry analysts, are Downey Regional Medical Center, Centinela Freeman Health System in Inglewood, Brotman Medical Center in Culver City, Century City Doctors Hospital and four Orange County hospitals owned by Santa Ana-based Integrated Healthcare Holdings Inc. including Chapman Medical Center in Orange and Western Medical Center in Santa Ana, one of three trauma centers in the county.

In interviews, senior executives at Centinela and Downey said they were considering closing their emergency rooms. Downey's chief operating officer, Rob Fuller, added that his hospital could close entirely as early as next year if its financial picture didn't improve soon.

"It's fasten your seat belt it's going to be a bumpy ride time," said James Lott, executive vice president of the Hospital Assn. of Southern California, a trade association.

The financial woes result from a multitude of developments:

* An increasing load of uninsured and low-income patients has resulted from overcrowding and the shutdown of public facilities. The number of uninsured patients visiting private hospitals, particularly in poor areas, has increased by one-third in Los Angeles County since 2002. California's Medi-Cal program for the poor reimburses hospitals at one of the lowest rates in the country.

* The closure of Martin Luther King Jr.-Harbor Hospital in Willowbrook last month left half a dozen nearby hospitals to absorb most of the 47,000 patients who used the public hospital's emergency room last year.

* Smaller community hospitals are drawing fewer patients as a few larger facilities attract a growing share of doctors and insured patients.

* As insurers have consolidated in recent years, they've squeezed many smaller facilities. Private insurance companies generally pay higher rates to larger hospitals with greater bargaining power.

* New, stricter state mandates on nursing ratios have raised labor costs, and a 2013 deadline to retrofit all hospitals to better withstand a major earthquake is estimated to be costing medical facilities $110 billion statewide.

The strains are being felt by patients.

Natalia Sanchez of South Gate took her 86-year-old mother, Emilia, to St. Francis Medical Center this month after the elderly woman suddenly lost feeling in her body. They waited 13 hours in an emergency room corridor before the mother was placed in a room. Even then, Sanchez said, she could never seem to find her mother's doctor. The experience was so frustrating that Sanchez moved her mother to a different hospital.

"It was a very bad experience," Sanchez said.

St. Francis officials said the average wait time for an emergency patient to be placed in a room last month grew to 11 1/2 hours. But they said the hospital had added more emergency room beds and nurses and had adopted a new system for treating emergency patients more efficiently.

The financial crisis coincides with a widening split between the "haves" and the "have nots" in the California hospital industry, experts say.

Although large, well-known facilities, such as Cedars-Sinai Medical Center in Los Angeles and Hoag Memorial Hospital Presbyterian in Newport Beach have seen their profits rise steadily in recent years and are adding beds, smaller hospitals, which are often in less affluent areas, are losing as much as tens of millions of dollars apiece each year.

In addition, because conglomerates such as Tenet Corp. have dramatically scaled back their presence in the area, many local hospitals are now independently owned and don't have deep pockets to fall back on.

Since 1996, more than 70 community hospitals have closed across the state, with a disproportionate share -- more than 50 -- in Southern California. Regionally, 14 emergency rooms have closed in the last five years, including 10 in Los Angeles County.

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