The rural hospital closure crisis: 10 things to know

Many rural hospitals across the nation are faced with financial challenges, causing some to scale back services and others to close.

10 things to know about rural hospital closures:

1. Across the U.S., more than 120 rural hospitals have closed since 2010, according to the Cecil G. Sheps Center for Health Services Research.

2. Thirty-one states have seen at least one rural hospital shut down since 2010, and the closures are heavily clustered in states that have not expanded Medicaid under the ACA.

3. Twenty rural hospitals in Texas have closed since 2010, the most of any state. Tennessee has seen the second-most closures, with 13 rural hospitals shutting down in the past decade.

4. The Sheps Center began tracking rural hospital closures in 2005. Since then, 163 hospitals in rural communities have shut down.

5. The number of closures has steadily increased over the past three years. Rural hospital closures hit a record high in 2019, with 19 shutting down.

6. A variety of issues have put rural hospitals in a fragile position, including low patient volume, heavy reliance on government payers, increased regulatory burden, rising pharmaceutical drug costs and the shift from inpatient to outpatient care, according to a report by the American Hospital Association.

7. Although for-profit hospitals accounted for just 11 percent of rural hospitals in 2013, nearly 40 percent of the hospitals that closed between 2013 and 2017 were for-profit, according to a report  by the U.S. Government Accountability Office.

8. Across the U.S., more than 600 rural hospitals are vulnerable to closure, according to an estimate from iVantage Health Analytics, a firm that compiles a hospital strength index based on data about financial stability, patients and quality indicators.

9. Sixty-eight percent of the hospitals vulnerable to closure are critical access hospitals — a designation that requires certain conditions be met, including being located at least 35 miles from another hospital.

10. Patient access to care suffers when a rural hospital shuts down, and consequently, patient outcomes can worsen. A working paper published by the National Bureau of Economic Research found rural hospital closures increased inpatient mortality by 5.9 percent.


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