By Bill Bishop
When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.
The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.
In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates.
But when the hospitals were divided between rural and urban, the researchers found a distinct difference. Mortality rates in rural areas increased 5.9 percent. This matched earlier studies, which found mortality rates increasing from 3 to 10 percent after a rural hospital closes.
About 15 percent of all U.S. hospitals have closed since 1990, and the rate of rural hospital closures has increased since 2010. “From an efficiency standpoint,” the researchers wrote, “rural hospitals exiting the market seems inevitable….”
But rural hospital closures “can have enormous negative implications for patient welfare.” When a rural hospital closes, transportation times to health care increase more for rural residents. But distance isn’t the only problem. The lack of public transportation in rural areas makes it harder for people, especially the elderly, to get to the closest hospital.
Also, when a hospital closes, there is an outmigration of healthcare professionals, diminishing access to care across the board. The researchers note that when a large hospital system in Kansas, Kentucky, and South Carolina closed, local physicians were offered jobs in urban areas. “(P)hysician relocation due to hospital closure exacerbates existing recruitment difficulties and systemic workforce shortages in rural areas,” the paper reports.
There is a cascade of problems that comes with rural hospital closures. Transportation times increase. Physicians are harder to find. Waiting times increase. Facilities that remain are overcrowded. This combination of factors leads to higher death rates.
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