Implications of Closing Rural Hospitals: Millions of Americans are in a Health Care Crisis

medical doctor holding senior patient's hands and comforting her

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By Dr. Sameer Suhail

Hospitals that fail in rural areas due to poor administrative management, inequitable payors, or other reasons should not be at the expense of patients who rely on those medical centers to provide accessible care close to home. Unfortunately, this is a reality for millions of Americans in rural and underserved communities. 

More than 500 rural hospitals in the U.S. are at immediate risk of closing, according to a report from the Center for Healthcare Quality and Payment Reform.

Nearly one-third of all Americans live in rural communities, and for these 60 million people, they depend on their local hospital to access quality and convenient life-saving treatment and primary health care. 

But the vitality of these community anchors is at risk due to substantial financial pressure, workforce shortages, and geographical isolation. Medical centers in underserved communities are in a vulnerable financial status, with close to half now operating at a loss. 

Why rural hospitals are in peril

Acute care hospitals in rural counties are generally small, with a median number of 25 beds. Many of the people who live in these communities are covered by Medicare and Medicaid which pays significantly less than private insurance. The hospitals are, therefore, forced to rely on local, state and federal spending or generous philanthropic donors. 

However, federal dollars and donations are not equitable across locations. A recent analysis reveals that hospitals with the most days of cash received more funding per bed than hospitals with fewer than 50 days of cash, further driving the extreme healthcare inequities in the nation. (National Library of Medicine, 2021)

The COVID-19 pandemic stacked unsustainable odds against struggling rural hospitals. Following executive orders to pause elective services, they saw a significant decrease in volume, which is their main source of revenue.

Furthermore, low worker recruitment and retention rates pose significant challenges for communities in remote locations. Ongoing staff shortages caused by worker burnout, with unprecedented numbers of nurses retiring or leaving bedside nursing. To fill in the gaps of workers, hospitals are turning to nurse staffing agencies that are seeing their highest labor costs in history. 

Economic anchors in communities 

Hospitals are economic drivers and anchor institutions for communities, and unquestionably stand as its strongest pillar. Hospitals create jobs for people of varying education and skill-levels and are often a rural county’s number one employer. For non-profit hospitals exempt from federal and most state and local taxes, law requires them to participate in community benefit programs to improve the health of their community. Hospital administration and medical staff who are pushed to the brink of their capacity face difficult decisions, including reducing critical services and complete closure.

Longstanding health inequities for 1 in 5 Americans

Statistically, rural Americans are older, sicker and poorer than suburban and urban populations. Exacerbated by the pandemic, social determinants of health contribute to health inequity in rural communities lacking essential health services. For this vulnerable population, more likely to be in the health care system, the fragility of their direct access to health care cannot be understated. Rural hospitals provide care across the continuum of care, from primary care disease prevention and management to inpatient medicine healing the sickest. 

  • Compared to urban hospitals, rural healthcare providers treat higher rates of patients addicted to opioids
  • According to the Centers for Disease Control and Prevention, adults in rural counties are more likely than residents in metropolitan areas to have a higher rate of smokers and obese people, a risk factor for many chronic diseases including type 2 diabetes, heart disease and cancer
  • Extreme barriers to behavioral health services 

Burden falls on patients

Losing critical access hospitals increases the distance for patients to travel to their primary care appointments. The access and affordability of travel is a significant barrier for many, breaking the continuum of care, as they can’t attend regular check-ups or refill prescriptions. It also increases the time when prompt emergency is needed, and every second counts to save a life suffering from trauma, heart attack or stroke.

For patients who travel to other facilities, they will face more resistance as tertiary hospitals are also already at capacity, with fewer physicians and nurses available to meet the high demand. Currently, hospitals around the country are without enough beds for their sickest patients, and their only options are boarding in the emergency departments. There are simply not enough hospital beds for every sick person in the United States. 

As a health care professional, it is my moral imperative to advocate for rural communities. The system is broken. It’s extremely complex. But when the consequences of losing rural hospitals are depriving human beings of dignified care, our brightest minds must be steadfast in finding a solution. 

We must support investing in rural healthcare. We must save rural hospitals.