March 27, 1987

Demise of Philadelphia General an Instructive Case; Other Cities Treat Public Hospital Ills Differently

JAMA. 1987;257(12):1571-1575. doi:10.1001/jama.1987.03390120017006

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DESPITE THE REMARKABLE staying power of public hospitals, not all have survived. The pattern of closure, however, is complex, especially in cities. Alan Sager, PhD, associate professor, Boston University, conducted a survey of hospital closings in 52 large US cities between 1937 and 1980. Defining a closure as "cessation of acute inpatient services in a hospital within the city boundaries," he found "only three public hospital closures or relocations outside the city between 1937 and 1950." From 1950 to 1959, there were six; from 1960 to 1969, there were three. From 1970 to 1980, however, there were ten.

"There was a burst of closings between 1978 and 1982, probably due to recession and economic problems," Sager reports; four more hospitals were shuttered between 1980 and 1983 for a total of 14 in the five-year period. However, there have been no closings among the hospitals in his sample since 1983. Sager