One in four community hospitals in the U.S. are public hospitals owned by a government and as such, face unique challenges because they tend to be smaller, less technologically equipped and treat a population that receives lower income and is more likely to be uninsured or covered by Medicaid.
That's the finding in a statistical brief by the federal Agency for Healthcare Research and Quality, which compared these 1,131 hospitals to their 2,944 private, not-for-profit counterparts and to all 5,162 community hospitals in 2008.
Additionally, those public hospitals in rural areas, 724, tended to have more patients per nurse, a lower percentage of registered nurses among licensed nurses, and more patients diagnosed with a high severity of illness than the public hospitals in metropolitan areas.
Public hospitals "play an important role in the healthcare safety net, providing care for patients who may have limited access to care elsewhere," says the report, by researchers for the agency.
"However, these institutions face unique challenges (because they) provide care for a large proportion of patients who have low income, are uninsured, or are covered by Medicaid. They serve a critical role as teaching institutions, and are often the first choice for trauma care."
Here are some findings from the report.
Public hospitals are—
1. Smaller, averaging 126 beds compared to 190 beds for private NFP hospitals.
2. Have lower occupancy rates, 51.9% compared with 58.9%
3. Provide a large amount of unreimbursed or under-reimbursed care, with 32.8% covered by Medicaid or uninsured, compared with 21% for private NFP facilities and 23.7% for all community hospitals.
4. Have a higher percentage of patients from the lowest income zip code, 34.5% compared with 25.7% for private NFP.
5. Likely to be in rural areas, with two out of three located in areas of low population, with even lower occupancy rates, 47.2%, compared with 60.7% in metropolitan areas and 59.7% in what the report calls "micropolitan," or small or medium sized towns.
6. Less likely to be part of large multi-hospital system compared with private NFP facilities, 26.1% compared with 61.1%. And only 21.5% of rural public hospitals were in multi-hospital systems.
7. Less likely than private NFP hospitals to have an approved medical teaching residency program than private NFP facilities.
8. Less likely to have a hospitalist on staff, with 28.5% compared with 50.3% for private NFP hospitals.
9. Public hospital stays are longer, 4.8 days compared with 4.6 for both private NFP and all community hospitals.
10. More likely to require mechanical ventilation, 29% compared with 2.6% and 2.7%.
11. Offered fewer "high technology" services, such as trauma, medical surgical ICU, neonatal ICU, CT or MRI, cardiac catheterization, cardiac surgery or transplant services. For example, while 27.5% of private NFP hospitals and 22.4% of all community hospitals offer cardiac surgery services, only 13.9% of public hospitals did.
12. Have fewer patients with a high severity of illness than private NFP and all community hospitals.