The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services


  • Gloria J. Bazzoli Ph.D.,

    Corresponding author
    1. Department of Health Administration, Virginia Commonwealth University, Richmond, VA
    • Address correspondence to Gloria J. Bazzoli, Ph.D., Bon Secours Professor of Health Administration, Department of Health Administration, Virginia Commonwealth University, P.O. Box 980203, Richmond, VA 23298-0203; e-mail:

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  • Woolton Lee Ph.D.,

    1. Department of Health Care Policy and Research, Virginia Commonwealth University, Richmond, VA
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  • Hui-Min Hsieh Ph.D.,

    1. Department of Public Health at Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Lee Rivers Mobley Ph.D.

    1. RTI International (Research Triangle Institute), Research Triangle Park, NC
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To examine the effects of safety net hospital (SNH) closure and for-profit conversion on uninsured, Medicaid, and racial/ethnic minorities.

Data Sources/Extraction Methods

Hospital discharge data for selected states merged with other sources.

Study Design

We examined travel distance for patients treated in urban hospitals for five diagnosis categories: ambulatory care sensitive conditions, referral sensitive conditions, marker conditions, births, and mental health and substance abuse. We assess how travel was affected for patients after SNH events. Our multivariate models controlled for patient, hospital, health system, and neighborhood characteristics.

Principal Findings

Our results suggested that certain groups of uninsured and Medicaid patients experienced greater disruption in patterns of care, especially Hispanic uninsured and Medicaid women hospitalized for births. In addition, relative to privately insured individuals in SNH event communities, greater travel for mental health and substance abuse care was present for the uninsured.


Closure or for-profit conversions of SNHs appear to have detrimental access effects on particular subgroups of disadvantaged populations, although our results are somewhat inconclusive due to potential power issues. Policy makers may need to pay special attention to these patient subgroups and also to easing transportation barriers when dealing with disruptions resulting from reductions in SNH resources.