Between 2010 and 2025, U.S. hospitals shut down at comparable rates whether they were in urban or rural areas, according to a research letter published Oct. 8 in JAMA Network.
Researchers from the Harvard T.H. Chan School of Public Health conducted the analysis. They built a national dataset of acute care hospitals from the American Hospital Association’s annual survey and tracked every closure and opening. A hospital counted as closed once it stopped offering inpatient care. The study did not include nonacute hospitals, federally owned hospitals or Indian Health Service facilities.
“Many policymakers have been treating hospital closures as a rural problem, but our data show it’s a national problem,” said Thomas Tsai, MD, the study’s corresponding author and associate professor of health policy and management at Harvard T.H. Chan.
Here are five things to know from the study:
1. Of the 4,962 hospitals in the analysis, 432 (8.7%) closed and 216 (4.4%) opened. That left 216 fewer hospitals and 24,399 fewer beds by the end of the study period.
2. Closures increased 4% annually, while openings declined 3% annually. Of the hospitals that closed, 315 shut down completely while 117 continued offering outpatient care. Those 117 included 45 rural emergency hospitals.
3. Closure rates were 9.1% for urban hospitals and 8.3% for rural hospitals, a difference the researchers did not find significant. Closures were concentrated in the counties with the highest social vulnerability.
4. For-profit hospitals closed at more than three times the rate of nonprofit hospitals: 21.4% versus 6%.
5. Safety-net, nonteaching and smaller hospitals were more likely to close, while critical access hospitals were less likely to close. New hospitals tended to be urban, for-profit and small. Safety-net hospitals and those with large Medicaid populations rarely opened.
The findings come as the pace of closures in 2026 has slowed. Becker’s has tracked six planned hospital and emergency department closures so far this year, compared with 23 throughout all of 2025. Even so, national hospital association leaders have said that financial distress is now showing up as service-line cuts, rural emergency hospital conversions and consolidations. Most of them expect closures to rise in 2027 as Medicaid cuts from HR 1 take effect, along with the expiration of enhanced premium tax credits.
