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Key Findings:
- The key consideration following closure of a public hospital is to ensure that the level of uncompensated care provided in the community (the safety net) is maintained. Some communities that closed their public hospitals developed local coverage programs to purchase care for the indigent uninsured; these arrangements facilitated continuing care and were associated with expanded ambulatory care and fewer preventable hospitalizations.
- A critical issue for most communities deciding to close a public hospital involved the ownership of facilities that would care for the indigent uninsured; the principle concern was how a change in ownership would affect the facility’s mission as a “provider of last resort.”
- All ownership models studied appear to have maintained existing levels of uncompensated services following closure of a public hospital when contracts and regulations were designed to address this issue.
- Medical education in the community appears to be maintained following closure of public teaching hospitals.
- Achieving the community goal of providing high-quality care to all citizens depends on careful needs assessment, planning, and consensus building. Planning includes determining the mission of any new facilities, carefully assessing local supply of and demand for health care, understanding local market forces, and determining an appropriate governance, financing and regulatory structure.
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