When Antitrust Fails: Public Health, Public Hospitals, and Public Values

In the past few years, large operating deficits have led governmental authorities in several major cities to close, sell, or substantially reduce the services of their public hospitals.' These decisions portend the arrival of what the New York Times has called a "looming crisis" in health care for the urban poor and uninsured. Should this crisis unfold, many public health programs are likely to be casualties, including those designed to treat and prevent the spread of communicable disease. Among others, programs aimed at the so-called "new" (multidrug resistant) tuberculosis are especially vulnerable to these compelling budgetary constraints. Poor urban populations face an elevated risk of contracting tuberculosis (TB); and when they do contract it, they often seek care in public hospital emergency departments.

The prospect of public hospital closures obviously threatens to eliminate or reduce these sources of care, which provide many of the most accessible sites for the treatment and control of the disease. Moreover, public hospitals administer outreach programs intended to educate and serve populations at high risk of contracting TB. Healthcare experts predict that not only will tuberculosis spread faster in the absence of public hospitals, but that their closures will also place extraordinary demands on mental health programs and homeless shelters.