Updated: Oct 29, 2021
We hear constantly that rural hospital closures are accelerating, and those stories are generally accompanied by plenty of handwringing over what will happen to the local population without a hospital of their own. Ironically enough, there has never been a national study to answer the question, so we were happy to see the Rural & Minority Health Research Center at the University of South Carolina step up recently to fill that knowledge void.
The center’s report, entitled Changes in Socioeconomic Mix and Health Outcomes in Rural Counties with Hospital Closures, is the first national study that uses county-level data to assess the connection between mortality rates and hospital closures in both small-town (micropolitan) and rural (non-core) communities.
If you were to sum up the authors’ findings in a single tweet, it would be this: “Beginning in 2013, counties with closures that occurred between 2005-2018 experienced increases in all-cause mortality and cause-specific mortality rates for cardiovascular disease.”
To break that down further, looking at all causes of mortality and after adjusting for age, the authors found a 9% to 16% increase in mortality among rural and small-town areas that experienced a hospital closure. For heart disease, specifically, a small-town hospital closure was associated with a 17% to 20% increase in mortality. (There were also signs of higher mortality rates due to injuries and respiratory issues, though not at statistically significant levels due to limitations with the data.)
The 10-page report is worth reading in its entirety, but here are a few additional headlines:
Since 2005, rural counties have seen 65 hospital closures, compared to 37 closures in micropolitan counties.
Since 2013, closures have been most pronounced in the Southeast – and especially in states that chose not to expand Medicaid.
Besides affecting mortality rates, hospital closures in rural and small-town communities also saw statistically significant increases in their unemployment and poverty rates.
For anyone needing good data on the depths of the rural healthcare crisis, this study shows that both length of life and quality of life are affected by hospital closures. But here’s a glimmer of hope: The study’s authors looked only at counties with a complete hospital closure – and full closure is not the only option for struggling communities.
At Rural Healthcare Initiative, our partners have helped dozens of local communities convert their traditional hospitals to a delivery model that’s more sustainable and effective – critical access, ambulatory care, or freestanding emergency department, for example. These models are effective at keeping the most important healthcare services close to home, helping to blunt the negative impact of a full closure.
As far as we know, no one has ever done a national study comparing health outcomes in counties that close their hospital versus those that convert to alternative delivery models. Maybe that would be a good follow-up project for the team at USC.