The increasing dependency of suburban residents upon physicians and hospitals located near their homes causes a serious economic problem for the District of Columbia, a prestigious urban study group has declared.
Because the city's health care industry has an annual payroll of $626.2 million and employs more persons than all the hotels, restaurants and bars combined, any decrease in hospital orhealth care system use carries with it a threat of layoffs and a decrease in the city's tax base, according to the District of Columbia Municipal Research Burueau, Inc.
In a report released today the independent agency said the District government has to devise ways to use presently under used hospital beds and personnel "before each hospital begins to act unilaterally and scurries to drop money-losing services."
"In choosing solutions to resolve the health care imbalance, the city must be cognizant of the impact of the health care delivery system not only on meeting health care needs but also on the District's economy," the report states.
According to the report, hospital occupancy has decreased slightly in four major catagories - medical-surgical, obstetric, pediatric and newborn - since 1974, but has decreased dramatically since 1963.
In 1963, 32 per cent of Northern Virginia residents admitted to hospitals were admitted in the District. By 1973 that number had dropped to 14 per cent. The admission of Montgomery County residents dropped during the same period from 53 to 32 per cent, while admission of Prince George's County residents remained stable.
"As suburban hospitals open more beds, the likelihood exists that suburban use of city facilities will decrease," the report warns, "and District hospitals will experience sharply declining occupancy.
"This already seems to be occuring, since in 1976 the average medical/surgical service occupancy in District hospitals slipped below the 80 per cent occupancy level that health care planners regard as being the minimum utilitzation level to be cost efficient . . . It is important to note." the report continues, "that three hospitals had newborn occupancy levels bordering on only 50 per cent."
There are 18 private and federal acute and psychiatric care hospitals in the District which employed almost 28,000 workers in fiscal 1975 and paid those workers $269.5 million.
"In addition to being a source of jobs for doctors and nurses, these hospitals provide employment for almost 18,000 semiskilled and unskilled laborers, such as lab and radiologist technicians and cafeteria, laundry and clearning workers. Although residency data on support personnel is unavailable, it is likely that a very high percentage of these lower employees are District residents," according to the report.
The report also points out that 8,100 doctors, nurses, dieticians, therapists and technicians live in the city . . . With payrolls of Approximately $180 million it can be estimated that District tax receipts from professional employees alone probably totaled $20 million in 1976 . . .
"The city's health care system is clearly a source of jobs and payroll for a substantial number of District residents. The city government should recognize the importance of the health care industry and should develop policies to strengthen this vital sector of the District's economic base.
"The economic outlook for the District's health care delivery system is not favorable at present. In recent years, health care services have rapidly expanded in suburban jurisdictions, with the result that suburban residents who once came into the central city for health care are increasingly finding these services in their own neighborhoods. Unless the present trend changes, this growth of suburban medical practice my threaten the continued operation of some hospitals and other health serivices in the District," the report warns.
The research group recommands the city:
Increase its licensing authority to better control hospital use and expansion or reduction of services and facilities.
Work toward using existing acute care hospital beds as nursing care beds in order to provide space for the increasing percentage of elderly residents of the city and to use under used hospital facilities.
Rechannel the efforts of health care personnel, such as nurses, nurses aides and other support personnel, away from the acute care hospitals and into such areas as home nursing.
Work to improve communications and planning between the city and suburban jurisdictions.
Albert P. Russo, director of the D.C. Department of Human Resourcers, which oversees health care planning for the District, could not be reached for comment on the report.