Residential segregation and the survival of U.S. urban public hospitals

Michelle J Ko, Jack Needleman, Kathryn Pitkin Derose, Miriam J. Laugesen, Ninez A. Ponce

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.

Original languageEnglish (US)
Pages (from-to)243-260
Number of pages18
JournalMedical Care Research and Review
Issue number3
StatePublished - 2014
Externally publishedYes


  • hospital closures and conversions
  • public hospitals
  • residential segregation
  • safety net

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)


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