Residents of Belhaven, North Carolina, fear that the economy will collapse because its hospital closed. Photo by Hyun Namkoong/ NC Health News

Rural hospitals in Southern states that serve disadvantaged communities, particularly minorities, have been the most likely to close in the past decade. That trend is likely to continue, according to a study that tracks “financial distress indicators” among rural hospitals.

“Communities that are served by rural hospitals at high risk of financial distress are much more likely to have a higher proportion of minorities in the community,” Dr. George Pink, a member of the research team, said during a recent Rural Health Research Gateway webinar titled “Financial Distress and Closure of Rural Hospitals.”

“And I guess what we’re concerned about is the impact and the implications this might have for exacerbating a lot of the existing rural/urban health disparities, but also, that closures may be exacerbating the disparities within rural communities as well,” Pink said.

The research team, based out of the North Carolina Rural Health Research Program (NC RHRP), generated a map of the 122 rural hospitals that have closed since 2005.

Source = NC Rural Health Research Program

In addition to tracking rural hospital closures, NC RHRP studies financial distress indicators for rural hospitals nationwide. Their data collection process is an attempt to explain why some hospitals close and others remain open. Of the closed hospitals, the researchers report that:

▪ Most closures are in the South (60%)

▪ Annual number of closures increased until 2017.

▪ Most are in states that have not expanded Medicaid.

▪ Patients in affected communities are probably traveling between five to 30 or more miles to access inpatient care.

▪ Most hospitals closed because of financial problems.

“To conclude, from this study, communities served by hospitals at high risk of financial distress had significantly higher percentages of residents who were black, who did not graduate high school, and are unemployed, again high-needs communities,” Dr. Pink reported. The communities also had high levels of fair-to-poor health, obesity, smoking and risk factors for potential years of lost life.

“This really is a very worrisome finding, because, essentially, it’s saying that the communities that are served by these hospitals are more vulnerable,” Dr. Pink said. “They are at increased risk of losing access, perhaps exacerbating some health disparities, as well as the loss of hospital and other types of local employment, which could make the consequences of closure even more concerning.”

82 rural hospitals have closed since 2010. For the original map and sortable data, visit the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, which created the map. 

NC RHRP’s research involves primary data collection, analysis of large secondary data sets, and in-depth policy analysis. The program’s team includes multidisciplinary health care professionals, along with experts in biostatistics, geography, epidemiology, sociology, anthropology, and political science. The research is funded by the U.S. Department of Health and Human Services Federal Office of Rural Health Policy.

While the trend of rural hospital closures due to financial stress is likely to continue, the team also points out that closures are still relatively rare. “It’s got a lot of press. There’s been 120 of them in the last decade,” Pink said. Out of 2,400 hospitals studied, 120 hospitals is still a relatively rare event.

The hospitals that did close, compared with other rural hospitals that were at high risk of financial distress but remained open, were found to share certain characteristics. The closed hospitals had a smaller market share, despite being in areas with higher population density. They were also located nearer to another hospital, and were located in markets that had a higher rate of unemployment in addition to a higher percentage of black and Hispanic residents.

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