It was a tragedy that stunned a small Texas town: 18-month-old Edith Gonzales, a grape lodged in her tiny throat, died in her desperate parents’ arms because the county’s only hospital and emergency room had closed for good a few months earlier.
Yet medical care analysts say the scenario that led to the death -- a population suddenly left without immediate access to urgent medical care -- is likely to repeat itself in a growing number of communities nationwide.
[READ: How Hospitals Are Changing]
A combination of health care economics, political forces and demographic trends have triggered a quiet epidemic of hospital closures throughout the country. The problem stretches from rural areas like Center, Tex., where young Edith died in August, to hard-hit urban communities in cities like Detroit, Los Angeles and Washington, D.C.
Experts say the closures are likely to continue, even as the Obama administration attempts to expand health care coverage to all Americans through the Affordable Care Act. In fact, some analysts say Obamacare may be unintentionally exacerbating the problem: To help pay for the program, the administration has cut federal reimbursements to hospitals that treat the uninsured, on the theory that those payments won’t be as necessary if everyone has health insurance.
While Edith’s death was shocking, “We don’t know how often that sort of thing happens,” said Alan Sager, a Boston University professor of health policy and management. That’s because the growing problem of “medical deserts,” he said, is much like the movement of a glacier: nearly invisible day-to-day, but “over time, you can see big changes.”
Dr. Brian Smedley, a health policy expert at the Joint Center for Political and Economic Studies in Washington, said the poor and underserved rural communities, where people are less likely to have quality health insurance, are more likely to suffer.
“Unfortunately, health care remains a commodity that’s bought and sold on the open market,” and hospitals largely decide what the market will bear,” Smedley said. “There’s reason for concern that the trend will escalate.”
The cornerstones of every modern health system, the total number of hospitals nationwide has steadily declined during the last decades. According to the American Hospital Association, there are about 5,700 hospitals in the country, but they tend to be unevenly distributed: only 35 percent are located in rural areas.
According to the federal Office of Rural Health Policy, researchers at the University of North Carolina have determined that there are 640 counties across the country without quick access to an acute-care hospital -- roughly 20 percent of the nation’s 29,000 residential areas.
In Center, Tex., the Shelby Regional Medical Center was the only hospital in Shelby County, one in a chain that collapsed last year amid a state and federal crackdown over reports of shoddy patient care and allegations of billing fraud. The nearest hospital, and the patient services that go along with it, is now 20 miles away -- probably too far, officials say, to have saved Edith.
While Shelby County Hospital closed amid alleged malfeasance, other hospitals are closing for more complex reasons, including sharp cuts to federal reimbursements, congressional gridlock and unintended consequences from the implementation of Obamacare.
Charlton Memorial Hospital in southeast Georgia became the state’s third rural hospital to close this year due to what administrators called ‘‘financial instability.’’ At Keokuk Area Hospital in southeastern Iowa -- a facility with fewer than 100 beds -- administrators fought to keep its doors open, laying off 24 people earlier this year in an attempt to deal with chronic financial deficits. In Mississippi, an ongoing fight between health industry giants Blue Cross-Blue Shield and HMA over reimbursements could shutter as many as a half-dozen hospitals statewide.
The situation isn’t much better in cities.