Caring for neighbors: an examination of nonresident use of New York City hospitals.

In 1989, almost 10 percent of all patients--or nearly 100,000 patients--hospitalized at facilities located in New York City were not city residents. Nonresidents are attracted to the city by the prestige and expertise of the city's hospitals; they are more likely than residents to require the hospitals' most sophisticated and specialized services, ranging from transplantation and coronary bypass surgery to treatment of malignant conditions. The largest numbers of nonresident patients, however, receive care for conditions that are relatively routine, care which would seem to be generally available at suburban hospitals. Although New York City hospitals continued to serve a substantial number of patients residing outside the city, the flow of nonresident patients seems to be slowly diminishing, particularly at the city's academic medical centers. (The specialty hospitals, on the other hand, seem to be attracting an increasing share of nonresident patients.) This decline occurred despite the one-third increase in population since 1960 in the New York State counties surrounding the city. To complicate matters, many New Yorkers are leaving the city for care. Almost 40,000 New York City residents were admitted to hospitals elsewhere in New York State, and perhaps another 20,000 to 40,000 may be receiving hospital care in other states. These trends have obvious implications for the city's hospital in their dual role as leaders in advanced and sophisticated medical care and as providers of vital patient care services to the city's population. The most highly specialized services can maintain clinical expertise and remain financially viable only if a sufficient number of patients can be attracted from throughout the metropolitan area and beyond. Likewise, the city's hospitals can be confident of fulfilling basic patient care needs only as long as New Yorkers do not look elsewhere for care. With the myriad pressures on our hospitals, the challenge of keeping them inviting and responsive will be formidable, but the construction of modern facilities, emphasis on patient-centered care, cultivation of strong relationships with communities and practitioners, and careful monitoring of patient flows and patient satisfaction should help the city's hospitals continue to attract patients, both from within the city and beyond the city limits.