If you were seriously injured in an auto accident and taken to a nearby city or county hospital, you might have to wait hours to get a bed. You also might find the staff shorthanded and the facility dangerously outmoded.
A shocking report from the National Association of Public Hospitals says that the average emergency room wait for a bed in America's public hospitals is more than 5 1/2 hours. In some cases, it may be several days.
Moreover, the report says, these hospitals, often regarded as the foundation of our nation's health system, are deteriorating in other ways. Unless they get help, "there will be a substantial curtailment of safety-net services in many urban areas."
It's easy for most Americans to say, "That's too bad, but it doesn't really affect me. I don't have to go to a public hospital for care. I can afford something better."
But that doesn't mean you and I can afford to ignore the deterioration of these facilities. While the impact of the public hospital crisis may be harshest on the poor, the disabled and the elderly, says Larry S. Gage, president of NAPH, "there will also be a substantial impact on the rest of the hospital industry that could lead to reduced access to care for all individuals."
As an article in the Journal of the American Medical Association has noted, public hospitals "do a job -- several jobs, in fact -- that everyone wants done, but no one else wishes to do."
They take patients that other institutions don't like to deal with: street people, addicts, the mentally ill, prisoners. They provide services that other institutions will not -- dealing with AIDS (one out of every five victims), drug use, teenage pregnancies.
Although public hospitals comprise only one percent of the nation's acute-care hospitals, they give succor to a substantial majority of patients who cannot pay and those on Medicaid and Medicare. Only 15 percent of the hospitals' inpatients and 10 percent of their outpatients have private insurance.
The average NAPH hospital registers more than 71,000 emergency department visits and 190,000 outpatient visits annually, admits 20,000 inpatients and delivers more than 4,000 babies. Some hospitals register as many as 400,000 clinic visits and 15,000 births a year. Public hospitals have become the "family doctors" for millions of disadvantaged Americans. In addition, they play a critical role in medical education, training more than 1 in 6 interns and residents.
But these vital hospitals are in desperate shape. The average physical plant is 26 years old, compared with just seven years for private hospitals. They suffer severe financial problems, losing an average of $9 million a year despite subsidies. Long waiting lines, overcrowding, staff shortages and lack of adequate equipment are common.
"Many hospitals now are literally functioning daily and nightly as if there were a disaster or combat in the cities," says Dr. Arthur Kellerman, medical director of the Emergency Department of the Regional Medical Center in Memphis.
Still, the NAPH white paper says that these facilities generally continue to offer high-quality medical services.
The deterioration of public hospitals is one reason why, at a time when most Americans are getting healthier and living longer, our inner cities have become medical disaster areas.
Over the long term, this country must revamp its health care system, from top to bottom. Costs are soaring (we spent $600 billion last year), but millions of Americans remain ill-served. Some 37 million have no health insurance.
Wide-ranging reform is not likely to happen soon. In the meantime, we could make a small but critical start by allocating funds to help finance care for the uninsured and by finding new sources of capital to rebuild the infrastructure of our public hospitals. They are hurting as much as the patients they serve.