Beyond Poverty: Healthcare Deserts

Pundits frequently point to poverty when discussing lack of access to healthcare. While poverty is a major barrier to accessing healthcare for low-income communities, the closure of emergency rooms, maternity care services and hospitals in general are affecting communities across the board. Regardless of poverty, there is less access to healthcare for everyone because of these closures and consolidations. Even if people have insurance, if there is no hospital in their community, they have no access. This, along with the shortage of healthcare professionals and the closure of pharmacies, is a big problem that has created healthcare deserts in Pennsylvania and nationwide.

According to the Pennsylvania Health Access Network (PHAN), there were 33 hospital closures in the past 20 years and 15 in the past five years. Thirty of those 33 hospital closures and 14 of 15 closures in the past 5 years were preceded by a merger or acquisition.

The Pennsylvania Department of Health “State of Our Health Report 2023,” found that many people face barriers to healthcare based solely on where they live. Health Professional Shortage Areas (HPSAs) are geographic areas with a shortage of healthcare professionals and facilities. Medically Underserved Areas (MUA) are areas with a shortage of healthcare services. The report stated that in 2022, about 2 million Pennsylvanians (16%) were living in dental HPSAs or mental healthcare HPSAs, and 500,000 (4%) were living in primary care HPSAs. An additional 337 dentists, 118 mental health professionals and 109 primary care physicians would be needed to remove these designations. Based on the 2020 Physician Health Care Workforce Re-Licensure Survey, there were only 91 primary care physicians in direct practice per 100,000 people in Pennsylvania. This results in decreased access to healthcare.

Access to maternal healthcare is also a big problem. The report found that about 32,000 women in Pennsylvania live in maternity care deserts where care is limited or absent because of lack of services or other barriers to access. There also is significant rural/urban disparity in access to obstetric and Neonatal Intensive

Care Units (NICU) services in Pennsylvania. Rural areas typically have less access to medical services in general than urban areas. In 2020, 95% of urban Pennsylvania residents were living within 15 miles of a hospital with an NICU but only 45% of rural residents were living within 15 miles of a hospital with NICU. Ten rural counties don’t have a hospital at all, further impacting access to local maternal and infant healthcare services.

Hospital closures and consolidations have increased in Pennsylvania. Healthcare monopolies, lower quality of care, unfulfilled charitable commitments, diminished competition and increased healthcare costs are often the result of consolidations.

Last year, Prospect Medical Holdings, Inc., the for-profit California-based owner of Delaware County Memorial Hospital in Upper Darby, began cutting services.  The maternity ward was the first to go, then the operating rooms and the I.C.U. and finally, the emergency department was closed.  Prospect Medical also suspended all services at Springfield Hospital, another acute care hospital in the same health system. By 2018, Prospect Medical Holdings owned 20 hospitals in six states. However, a CBS News investigation found that five of the 20 hospitals owned by Prospect Medical have closed.

The shut-down of Delaware County Memorial has now sparked a legal battle. When Prospect purchased the non-profit Crozer Keystone Health System in 2016 for $300 million, Prospect agreed as part of that sale not to close any hospitals within 10 years. The Foundation for Delaware County, Crozer Keystone Health System and Delaware County Council filed an emergency injunction in September to temporarily stop the closure, because it violated the “no-close” provision of the 2016 contract.  The case is now due to come before the State Supreme Court.

The University of Pennsylvania Health System (UPHS) recently announced its plans to acquire Doylestown Health in Bucks County. The sale will include Doylestown Hospital, a 247-bed community teaching facility. Doylestown Hospital will join Chester County Hospital in West Chester, Lancaster General Health in Lancaster and Princeton Health in Plainsboro Township, N.J. under the UPHS umbrella.

In June 2023, Jefferson Health closed acute care, general surgery and emergency services at Einstein Medical Center Elkins Park, in Montgomery County.  Jefferson plans to convert the hospital solely into a physical rehabilitation center.

Although Philadelphia has a wealth of healthcare facilities, major hospitals that served primarily low-income communities and Medicaid patients have closed in the last 15 years. They include Mercy Hospital, Hahnemann University Hospital and St. Joseph’s Hospital. These hospital closings don’t just affect its patients and the surrounding communities. The staff now has to find employment at other facilities.

Closures of hospitals and healthcare services have created healthcare deserts in communities statewide. Medical professionals, patients and lawmakers alike have called for government action following each new hospital closure. State lawmakers have had enough and are drafting legislation to stop this unfortunate trend.

Part 2: Government intervention – 1/24/24

###

Share Your Insights

What policies and services should our government leaders implement?

What do they need to do differently to support our communities?