Are rural hospital closures becoming a crisis?

Perhaps according to Austin Frakt. He writes in JAMA Forum:

In every year since 2011, more hospitals have closed than opened…For example, 15 of the 21 hospitals that closed in 2016 were in rural communities, and since 2010, nearly 90 rural hospitals have done so. Hundreds more are at risk of closure.
One source of financial challenges to rural hospitals is shrinking populations, which means fewer patients to fill beds. Although populations in urban counties have increased since 2000, those in half of rural counties have fallen. Shrinking populations also exacerbate other threats to rural hospitals’ finances. For example, care has been shifting from inpatient to outpatient settings. Although hospitals can and do have outpatient departments, those face competition for patients from nonhospital outpatient clinicians and facilities.
The decision by some states not to expand Medicaid also plays a role, according to a 2018 study in Health Affairs. The vast majority of recent hospital closings have been in states that have not done so.

Sure driving farther (often much farther) can be inconvenient, but does it matter for health outcomes? The answer, according to Frakt, is ‘yes’.

The most obvious consequence of a rural hospital closure is reduced access to hospital care for the population it served. Analysis by the Medicare Payment Advisory Commission found that about one-third of hospitals that closed since 2013 were more than 20 miles from the next closest hospital. This can increase the risk of bad outcomes for conditions requiring urgent care, including that for high-risk deliveriestrauma, and heart conditions. A recent study in JAMA, for example, found that loss of hospital-based obstetric services in rural areas is associated with more preterm births, putting greater risk on mother and child.

Fewer hospitals also means higher cost due to less competition.

The closure of a hospital also removes it as a competitor to other hospitals. One well-established consequence of lower hospital competition is increased hospital prices charged to commercial market payers.

Leave a Reply

Your email address will not be published. Required fields are marked *