Factors Associated with Closures of Emergency Departments in the United States

Emergency departments (EDs) in safety-net hospitals are significantly less likely than their competitors to remain open.

Federal law requires emergency departments to treat all patients, even those unable to pay for their visits. Uninsured and underinsured patients increasingly rely on emergency services. Between 1990 and 2009, more than 600 emergency departments shut down.

This study analyzed factors related to emergency department closures between 1990 and 2009. Of particular interest to the authors were market forces, including competition among hospitals; the authors used the Herfindahl index to calculate market share among hospitals within a 15-mile radius. A safety-net hospital was defined as one whose share of Medicaid discharges was at least double the market average.

Key Findings:

  • The presence of at least two emergency departments within a market increased the likelihood that one would close.
  • Counties in the highest of three poverty categories were more likely to have their emergency services discontinued.

This nationwide study identified risk factors for emergency department closures between 1990 and 2009. As uninsured and underinsured patients lose access to primary care services, they often turn to EDs; this could increase the number of safety-net emergency departments, those currently at the highest risk for closure.