Nationwide acute care hospital closures are outpacing new openings, with similar rates of shutdown among facilities in urban and rural regions alike, according to new research from Harvard T.H. Chan School of Public Health.
From 2010 through 2025, the U.S. saw 432 hospital closures and 216 new openings, reflecting a net loss of 216 and about 24,400 beds, the researchers wrote in a JAMA research letter published Thursday. Eighty-four million people lived in areas affected by a hospital closure, according to the study.
The hospital deficit has accelerated over time, with closures increasing by 4% year over year while new openings slowed by 3% with each passing year.
Of note, 117 of those closed facilities continued delivering outpatient services, including 45 that transitioned to a rural emergency hospital designation.
There were three times as many for-profit hospitals among the closures as nonprofits, researchers found, with closures also more frequent among safety-net hospitals, nonteaching hospitals, smaller hospitals, those in Medicaid non-expansion states and those in counties with greater social vulnerability.
Notably, they found that closure rates were statistically similar between rural and urban hospitals.
That finding lands as policymakers have typically focused their hospital closure concerns on rural communities, as most evident with the $50 billion Rural Health Transformation Program that accompanied broader cuts to the Medicaid program. The researchers noted in their letter that no new support funding has been enacted for urban safety net hospitals—which a prior Harvard T.H. Chan analysis has flagged as particularly susceptible to the One Big Beautiful Bill’s Medicaid cuts.
“Many policymakers have been treating hospital closures as a rural problem, but our data show it’s a national problem,” Thomas Tsai, M.D., associate professor of health policy and management at Harvard T.H. Chan and one of the study’s coauthors, said. “We must shift away from only asking ourselves how we can save rural hospitals, and start asking: How do we protect access to hospital care for vulnerable communities, wherever they are?”
The researchers did note that 3.8 million rural residents living in service areas with a closure often had further to travel to reach their next-nearest hospital. Reopening all the closed hospitals would reduce the median distance to their next-nearest hospital from 17.6 kilometers to 10.1 kilometers.
Meanwhile, newly opened hospitals during the study period were often concentrated among urban, for-profit and smaller hospitals. New openings were “rarely” safety net hospitals or those serving a higher proportion of Medicaid patients.
The researchers relied on the American Hospital Association’s annual survey and other secondary sources to spot and characterize each opening and closing. Nonacute hospitals, those owned by the federal government and Indian Health Service hospitals were not included in the tallies.