Impact of Hospital Closures on Quality of Care in New York City: An Analysis of the New York State Commission on Health Care Facilities in the 21st Century

Abstract

Is higher hospital volume associated with better health outcomes? It depends. Academic literature has shown the relationship to be true in some cases, particularly with complex surgical procedures. However, the hospital volume-quality relationship has been applied to business practices and policymaking that may have extended beyond its empirical findings.

The implementation of recommendations proposed in December 2006 by the New York State Commission on Health Care Facilities in the 21st Century, also known as the Berger Commission, is one example of governmental action that has cited the volume- quality relationship. The Commission believed that concentrating inpatient admissions at high volume hospitals would in turn raise quality of care. Therefore, eliminating excess bed capacity by downsizing or closing low-volume and financially failing hospitals would theoretically improve health outcomes in the region. Eventually, along with a multitude of other restructuring efforts, four out of nine of the hospitals recommended for closure by the Commission closed their doors by the end of 2008.

This thesis evaluates the impact of hospital closures recommended by the Berger Commission on the quality of care in the local community. To do so, it uses a combination of t-tests and difference-in-difference regression model to quantify the relationship between hospital closures and quality of care through five quality measures: (a) overall in-hospital mortality rate, (b) acute myocardial infarction (AMI) in-hospital mortality rate, (c) 30-day readmission rate, (d) postoperative complication rate, and (e) average length of stay (ALOS), with data from 2006 to 2009.

The statistical model shows mixed results for the five quality measures analyzed. Overall in-hospital mortality rate increased for patients living near the closed hospital. AMI in- hospital mortality rate as well as postoperative complication rate increased for both patients living near the closed hospital and patients who received care at a nearby hospital, called a "coverage partner" of the closed hospital. In addition, 30-day readmission rates decreased for patients living near the closed hospital, while ALOS stayed constant for both patient populations.

The thesis concludes with reflections on the Berger Commission and government- mandated hospital closures in general. Finally, using the insights taken from the findings of this analysis, it offers recommendations for managing future hospital closures in a way that would potentially minimize any negative effects on quality of care.