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Rural recreation counties have higher-than-average rates of public-sector hospitals, according to researchers. Serving both local rural residents and visitors, the fiscal health and viability of these public hospitals is a big concern as local tax revenues decrease and demand soars during the coronavirus pandemic.

“The reason we’re thinking about public health and rural hospitals is pretty obvious right now with the spread and impact of coronavirus,” said Mark Haggerty, a Headwaters Economics researcher who studies fiscal policy and local economic development in rural America.

“The rural health care system is already getting by on a shoestring, with rural hospitals closing and remaining hospitals being easily overwhelmed, especially in these rural communities that have demands beyond the local population.” 

Haggerty is concerned that public-sector hospitals, partially funded by taxpayers to remain open and available to both year-round local residents, are facing a combined problem of increased demand and declining local government revenues. 

“It’s important to understand how to stabilize funding for rural hospitals just like when we’re looking at steady rural county government budgets,” Haggerty said. 

He said that rural recreation counties are both exposed to risks of spread in the pandemic while also having limited services and options to pay the bills. “My first question is how many of those rural hospitals are publicly funded, what is the landscape of local government health care in rural counties?” Haggerty asked.

With rural counties served by taxpayer-funded public hospitals, “is that hospital at greater risk to closing now than a privately funded hospital? I don’t know the answer to that, but it’s an important question,” he said.

Haggerty found that nationwide, 483 counties (15%) have public, locally funded hospitals only. Nearly one-third of rural counties, though, rely entirely on public hospitals funded by local governments. Fifty-three percent of rural recreation counties in the West are served only by public hospitals.

Local health services are often delivered by local governments in rural communities where low patient volume makes a for-profit model cost-prohibitive, Haggerty said. “Public hospitals and health districts are a critical component of the U.S. health care system. They are the front line and in many rural counties the only critical care and public health provider.”

In mid-March, just as the coronavirus was spreading, Haggerty was camping near Moab, Utah, for a spring break trip he had been planning with his kids. He decided to return home to Montana, worried that the pandemic would hit rural recreation areas like Moab.

“The community has only three critical care beds and visitors were flocking from metro areas and Colorado resorts where clusters of infections had already appeared. The county health department pleaded with the city and county to close hotels and campgrounds and ask people to go home. The order to evacuate campgrounds and close hotels was delivered March 17,” Haggerty wrote in a blog post.

Moab’s concerns appear justified, as the Daily Yonder reported at the time, “Rates of coronavirus infection in rural counties with large tourist and recreation economies are more than three times higher than for rural counties with other kinds of economies.”

Haggerty tracked the data and confirmed that some rural areas were indeed facing increased demand from seasonal visitors. “Colorado’s cases rose first in mountain resorts where tourists converge from across the globe and wealthy urbanites sought refuge in second homes and vacation rentals. It is not a surprise that other recreation hubs such as Bozeman, Montana, and Sun Valley, Idaho—with busy airports, ski areas, and access to public lands—are the epicenters of Covid-19 cases in western states,” Haggerty wrote on his blog.