When Rural Hospitals Close, The Physician Workforce Goes
When Rural Hospitals Close, The Physician Workforce Goes
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DOI：
10.1377/hlthaff.2019.00916
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发表时间：
2019-12-01
期刊：
影响因子：
9.7
通讯作者：
Martsolf, Grant R.
中科院分区：
文献类型：
--
作者：
Germack, Hayley Drew;Kandrack, Ryan;Martsolf, Grant R.
在过去十年中，农村医院关闭率一直在上升。关闭几乎肯定会限制农村居民获得重要的住院服务，它们也可能在重要方面与当地卫生保健系统的医生供应有关。我们使用1997-2016年期间地区卫生资源文件的数据来研究农村医院关闭与关闭前和关闭后几年不同专业医生供应之间的关系。我们观察到，在关闭之前的几年里，普通外科医生的供应量每年减少8.3%。我们还发现，农村医院关闭与外科专家供应的立即和持续减少以及多个专业医生供应的长期减少有关，包括关闭后六年及以后的初级保健医生供应平均每年减少8.2%。这种动态关系可能导致农村居民获得保健的机会减少。未来的政策努力必须侧重于支持和维持不依赖医院的医疗保健提供模式。
Rates of rural hospital closures have been increasing over the past decade. Closures will almost certainly restrict rural residents' access to important inpatient services, and they could also be related in important ways to the supply of physicians in the local health care system. We used data from the Area Health Resources Files for the period 1997-2016 to examine the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure. We observed significant annual reductions of up to 8.3 percent in the supply of general surgeons in the years leading up to a closure. We also found that rural hospital closures were associated with immediate and persistent decreases in the supply of surgical specialists and long-term decreases in the supply of physicians across multiple specialties-including an average annual 8.2 percent decrease in the supply of primary care physicians in the six years after a closure and beyond. This dynamic relationship could lead to reduced access to care for rural residents. Future policy efforts must focus on supporting and maintaining health care delivery models that do not depend on hospitals.