The American Public Health Association,
Being cognizant of the pervasive and unrelenting crisis of the nation’s approximately 43 million citizens who lack health insurance;1 and
Recognizing that the primary care facilities which constitute the nation’s health care safety net, including community health clinics, local public health clinics, public hospital outpatient facilities and the nation’s nearly 5,000 hospital emergency departments, have historically borne a disproportionate share of the responsibility for treating the uninsured;2 and
Being aware that a recent Institute of Medicine report on America’s health care safety net noted that it is “intact but endangered” as a result of the rising number of uninsured patients in the face of shrinking government subsidies;3 and
Acknowledging that the community hospital emergency department is unique among safety net providers due to its 24-hour access for medical and psychiatric emergencies, as well as its federal mandate under the Emergency Medical Treatment and Active Labor Act (EMTALA) to provide medical services to all individuals regardless of insurance status;4 and
Realizing that 18 percent of the nation’s uninsured rely on the hospital emergency department as their usual source of medical care;5 and
Understanding that the trend of hospital closures is accelerating, with 43 closures of general, short-term acute care hospitals in 19986 and 64 such closures in 1999;7 and
Recognizing that proximity to emergency services is affected by hospital closures, with individuals having to travel more than 20 miles to the nearest emergency department in 27 percent of the cases of rural hospital closures in 1998,6 and in 43 percent of such cases in 1999;7 and
Showing concern that the closures of community hospital emergency departments impose significant risks to the public health and are different from closures of other safety net facilities because they affect not just the uninsured, but everyone, including those who are insured; and
Recognizing that the American College of Emergency Physicians has adopted a policy concerning “Responsibilities of Acute Care Hospitals to the Community,” which begins by stating that “The American College of Emergency Physicians (ACEP) believes that the interests of communities are best served when acute care hospitals and members of their organized medical staffs work together to ensure unrestricted access to quality emergency care for all individuals in their community service areas” and concludes by affirming that “Hospitals must ensure that sufficient resources are committed to meet changing community needs. Reductions in hospital emergency services, including closures of emergency departments, must not be undertaken without full consideration of the impact on the public’s ongoing access to emergency care,”8 and
Concluding that it is in the mutual interests of APHA and ACEP to work cooperatively in studying the effects of such closures on health care access and the impact on public health, therefore
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