Yes, you read that correctly. Health Affairs reported in its May 2015 edition that “Hospital Closures Had No Measurable Impact on Local Hospitalization Rates or Mortality Rates, 2003-11.” The article declares that “these findings may offer reassurance to policy makers and clinical leaders who are concerned about the potential acceleration of hospital closures as a result of health care reform.”
The fact that the authors of this article concluded with this statement does not make it so. With the help of our research colleagues at the Universities of Minnesota and North Carolina, NRHA offers the following observations in response:
1. This was predominately a study of urban hospital closures: Only 44 of the 195 hospitals that closed (22 percent) were rural.
2. The 44 rural hospital closures in the study occurred from FY 2003-11. The pace of rural hospital closures has increased considerably since that time (UNC closure data). When multiple hospital closures occur in neighboring rural areas (e.g., some of the recent closures in Texas), beneficiaries likely will be travelling much greater distances to the next nearest hospital.
3. The authors did acknowledge in their discussion that they did not examine the totality of effects of a hospital closure on a community and mentioned potential economic impacts. It is important to emphasize that the implications of closing a hospital in a rural community with no other hospital are very different from a closure in an urban area with multiple other hospitals very nearby, often on the same block. (e.g., potential loss of physicians as well as other health care services besides inpatient care). The April UNC Findings Brief, "A Comparison of Closed Rural Hospitals and Perceived Impact,” addresses some of these issues.
4. Many rural hospitals are now the proud owners and operators of their associated clinics. If the hospital closes, the employers for the primary care practitioners are now left unemployed. This could cause a downward spiral of services to the point where nothing is left.
So the authors may state that closures don’t matter, but that doesn’t make it true. Rural health care is like Arctic Tundra, once stepped on, it’s gone. Let’s agree to stop stepping on rural health care and look for ways to modernize it for current and future generations.