One of New York City’s oldest hospitals currently finds itself in what might be termed critical condition.

Acquired over a decade ago by the Mount Sinai Health System, the 799-bed Beth Israel hospital on East 16th Street, founded in 1890, has been slated for eventual closure and sale since 2016. Community residents now await the outcome of a last-ditch suit they’ve brought to block the State-approved closure. Even as they do, some of Beth Israel’s medical services have atrophied and staffing has dwindled, as employees seek more secure jobs elsewhere.

At first blush, this may merely seem a continuation of a long and familiar story. Since 1996, over 50 hospitals have closed statewide, with more than a third taking place in New York City. And in the past two decades, over 21,000 beds have been lost across New York State, declining from almost 74,000 in 2003 to 53,000 in 2020.

Beth Israel would, however, be the first New York City hospital to close since before 2020 – the fateful year when the first wave of desperately ill Covid-19 patients deluged our hospital system. The approaching fifth anniversary of the start of the pandemic should prompt policymakers to reconsider what returning to the pre-pandemic status quo of steady hospital shrinkage in New York City might mean for the future.

In June 2020, the Community Service Society of New York issued a report entitled “How Structural Inequalities in New York’s Health Care System Exacerbate Health Disparities during the COVID-19 Pandemic: A Call for Equitable Reform.” It found that Black New Yorkers and other people of color had a Covid-19 mortality rate at least twice that of White New Yorkers in the earliest days of the pandemic, when patients needed to rely on hospital-based care. And it linked high Covid-19 mortality rates to the location of hospital closures, which mostly occurred in low-income neighborhoods, neighborhoods where people of color live, and where there were fewer patients with health insurance or the means to pay for care.

For example, in the pre-pandemic years, Queens witnessed closures of four safety-net hospitals (those serving patients regardless of income or health insurance coverage): St. Joseph’s in Fresh Meadows, 2004; Parkway in Forest Hills, 2008; Mary Immaculate in Jamaica, 2009; and St. John’s in Flushing, 2009.

In part because of these closures, hospital-based care has not been not equally, or even logically, distributed in New York. There are, for example, 1.5 hospital beds per 1,000 people in Queens compared to 6.4 beds per 1,000 people in Manhattan. And when the pandemic struck with all its deadly fury in the spring of 2020, the hospital closures in previous years notoriously left the public Health + Hospitals/Elmhurst as the sole, beleaguered safety-net hospital serving one of the country’s Covid-19 epicenters.

As with the case of Beth Israel, hospital closures often ensue from mergers and acquisitions, especially in rural and underserved areas. When hospitals are acquired, some units, such as intensive care, labor and delivery, and psychiatric care, may be closed, forcing patients to travel out of their communities for this care.

National research offers evidence that hospital closures also reduce access to care, quality of care, and drive up prices. As a result of hospital closures, there can be a reduction in access to emergency care at nearby hospitals, decreased duration of service per patient at those hospitals, and increased deaths from heart attacks and accidents in the affected communities. Closures are associated with a drop in quality-of-care measures, increased mortality for certain conditions, and also contribute to increased numbers of emergency department visits. Several studies have also found an association between hospital consolidation and rising health insurance premiums.

The effects of hospital closures in New York City lend credence to such national findings. For example, after the 2010 shuttering of St. Vincent’s Hospital in Greenwich Village, four nearby hospitals saw statistically significant increases in emergency department, inpatient, and ambulatory care activity. And The New York Times recently reported that another East Side hospital, NYU Langone, has already seen a more than 30 percent increase in emergency department visits from Beth Israel’s coverage area.

Based on this evidence, the Community Service Society has urged New York’s City Council to pass proposed resolutions currently before it calling on the State and Mount Sinai Health System to keep the 16th Street Mount Sinai Beth Israel hospital campus open.

We also urge Governor Kathy Hochul to sign the Local Input in Community Healthcare Act, passed by both houses of the State Legislature last spring. It would provide public notice and public engagement when a general hospital seeks to close its doors, or close a unit that provides maternity, mental health, or substance use care.

Whatever the outcome for Beth Israel may be, it’s long past time for a fuller public dialogue about the wise and fair allocation of hospital resources across the city and state.