Hospitals Closed, Lives at Risk
A 10 percent increase in hospital mortality from heart attacks and an increase in length of stay: these are the effects of hospital closures highlighted by the study The impact of budget cuts on individual patient health: Causal evidence from hospital closures, published in the Journal of Health Economics by Simone Ghislandi (DONDENA, Bocconi), Anna-Theresa Renner (TU Wien) and Nirosha Elsem Varghese (CERGAS, Bocconi).
The analysis, conducted on acute myocardial infarction (AMI) patients in Italy between 2008 and 2015, shows that increased travel time to the hospital is the main factor explaining the increase in mortality, underscoring the crucial importance of considering geographic accessibility to health care services in policy decisions regarding hospital network reorganizations.
“Hospital closures have often been motivated by lower efficiency and effectiveness of small hospitals. At the same time, however, a closure, if not well planned, reduces the density of points of care, particularly penalizing patients in emergency conditions. Our study focuses precisely on this second aspect, showing that hospital closures had a significant negative impact on the health of patients hospitalized for that quintessential acute medical condition, acute myocardial infarction, particularly on in-hospital mortality,” says Simone Ghislandi, associate professor of health economics at Bocconi. “Increased travel time is the main reason behind this increase in mortality.”
The effects of closures: rising mortality and longer hospital stays
The study shows that hospital closures caused a 10 percent increase in in-hospital mortality, which is about 0.7 percentage points higher in the likelihood of in-hospital death following an acute myocardial infarction for patients affected by the referral hospital closure. At the same time, there was a 0.3-day increase in the length of hospital stay, indicating a possible impact on the quality of care received.
The authors note how the increase in hospital mortality represents a conservative estimate of the total effect on heart attack mortality, as it is reasonable to assume that as the distances traveled by ambulance increased, the mortality before reaching the hospital also increased.
Geographic and demographic inequalities: who is most affected
The negative effects of hospital closures are not uniform throughout Italy. The study shows that the consequences on hospital mortality are heavier among female patients, the elderly, and patients treated in hospitals located in southern Italian regions, where travel time to the hospital increased significantly more than in northern regions.
“Geographic disparity in accessibility to health services emerged as a crucial factor,” Ghislandi points out. “Closed hospitals were often located in remote areas or in regions with less efficient transportation infrastructure, significantly increasing travel times for critically ill patients.”
A lesson for health policy
The results of this study raise fundamental questions about public health policy choices, especially in the context of economic recovery plans that include rationalization of the hospital network. The increase in hospital mortality related to longer travel times to the hospital shows that closure decisions cannot be based solely on economic criteria, but must carefully consider geographic accessibility to health services.
“Our results are crucial for planning an efficient geographic allocation of health services,” Ghislandi concludes, “and suggest the need to ensure that rationalization of the hospital network does not compromise timely access to emergency care.”
As financial pressures on public health systems grow, the data presented in this study provide a critical empirical basis for guiding more equitable and efficient health policies, so that cost savings may not engender an unacceptable human cost.
Simone Ghislandi, Anna-Theresa Renner, Nirosha Elsem Varghese, “The impact of budget cuts on individual patient health: Causal evidence from hospital closures”, Journal of Health Economics Volume 101, May 2025, DOI https://doi.org/10.1016/j.jhealeco.2025.102975
