There has been a rise in the number of hospital closings across the country, and particularly in rural areas, leaving patients without options. In fact, every year since 2011, more hospitals have closed than opened. This not only makes acute care less accessible, but closings can directly affect the economic conditions of the surrounding areas.
“Options are dwindling for many rural families, and remote communities are hardest hit,” said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota.
Consultancy Veda Partners health care policy analyst Spencer Perlman agreed, indicating “rural hospitals with a smaller footprint may have less room to negotiate rates with managed care companies and are often hobbled by more older and poorer patients,” so they are more likely to be hit with negative margins and shut down, leaving these communities with limited care options.
Since 2010, there have been an estimated ninety rural hospital closings, and hundreds of others are thought to be at risk for the same fate. This means those who need immediate medical attention, including pregnant women in labor, are left having to commute significant distances to receive the care they need. One study reported that greater travel time to hospitals is associated with higher mortality rates for coronary artery bypass graft patients, and a study published by JAMA earlier this year found that higher-risk, preterm births are more likely in counties without obstetric units, an issue for those facilities in more desolate areas.
Ms. Kozhimannil, a co-author three studies on the matter, said, “What’s left are maternity care deserts in some of the most vulnerable communities, putting pregnant women and their babies at risk.”
When a hospital closes, many specialists are booted out along with it, and treatment for mental health and substance use are among those most likely to be cut short. Since hospitals tend to offer a wealth of jobs, closures mean cutting employment in these areas and leaving needed physicians without job options. A study in Health Services Research found that when a community loses its only hospital, per capita income falls by about 4 percent, and the unemployment increases by 1.6 percent.
“There are real trade-offs between consolidating expertise at larger centers versus maintaining access in local communities,” said Karen Joynt Maddox, a cardiologist and health researcher with the Washington University School of Medicine. “The problem is that we don’t have a systematic approach to determine which services are critical to provide locally, and which are best kept at referral centers.”
Many factors can underlie the financial decision to close a hospital, including a decrease in rural populations, mergers and acquisitions, a consolidation of services, and more services being shifted to outpatient settings.
The decision by many states not to take advantage of federal funding to expand Medicaid as part of the Affordable Care Act also had a direct correlation with closings, researchers found. Studies reported that hospitals in non-expansion states took a financial hit and were far more likely to close. Thus, whether a sufficient number of hospitals will remain available to those who need them has to do, at least partially, with a state’s decision to expand or not expand this program.