“Nobody is accountable for identifying the hospitals that are needed for the public,” says one expert. “There is no free market and there is no government accountability.” (Photo: Shutterstock)

Before health care investor Joel Freedman shutters the money-losing hospital he controls in the heart of Philadelphia, he must craft a plan to remove all the street signs that direct people to its emergency room.

Medical care, emergency or not, will no longer be available at Hahnemann University Hospital under a proposal being considered this month by the federal judge overseeing the bankruptcy of the 171-year-old institution and its parent company.

The plan, which faces significant opposition, has raised questions about where the people who rely on Hahnemann will be treated. It also highlights the financial stress urban hospitals face, operating in a health care system that pushes administrators to compete for patients with high-quality private insurance. In rural areas, the situation is even worse.