Rural hospital closures have spillover effects for other nearby facilities, researchers warn

Shutting down a rural hospital places additional strain on the emergency departments and inpatient services of surrounding hospitals up to 30 miles away—a key study finding in light of several recent warnings of tight finances and impending rural closures.

Specifically, a Penn State College of Medicine review of 53 rural hospital closures found that emergency department visits increased by an average 10.22% among 93 “bystander” hospitals two years after a closure. Nearby hospitals’ admissions also increased by 1.17% two years following a shutdown, according to the study.

“This research confirmed a problem for the healthcare field that many already suspected,” Daniel George, associate professor at the college of medicine and a study coauthor, said in a release. “The question now becomes how researchers and policymakers can develop solutions to help bystander hospitals handle increased volume.”

While the health impacts of hospital closures on surrounding communities have been established, the researchers said their preliminary reviews are, to their knowledge, among the first to investigate the spillover impact of rural closures on other providers’ operations.

To hear more about what rural hospitals need to do to survive, listen to our podcast Podnosis


To do so, they reviewed closures of hospitals with more than 25 beds logged by the UNC Sheps Center for Health Services Research from 2005 to 2016. They also looked at changes in the visits and admissions of any hospitals within a 30-mile radius two years before and after a nearby hospital’s closure.

Two-thirds of the 53 qualifying rural hospital closures occurred within the Southern U.S., according to the researchers, with just over a fifth located in Appalachia.

The resources found a 3.59% increase in surrounding hospitals’ average emergency department visits two years ahead of a rural hospital closure, then followed by a 10.22% increase two years after shutdown. On the other hand, average admissions among nearby hospitals decreased 5.73% in the two years prior to a close before reaching the 1.17% average increase post-closure. Both of the post-closure volume shifts represent statistically significant increases.

“We know rural areas, especially regions like Appalachia, are at increased risk for diseases of despair including alcoholism, accidental poisonings and suicide,” Jennifer Kraschnewski, M.D., director of the Penn State Clinical and Translational Science Institute and a coauthor, said in a release. “Increased burden at bystander hospitals and healthcare institutions may cause these problems to proliferate if other public health interventions aren’t identified and implemented.”

UNC’s dataset shows rural hospital closures reached a peak of 19 with the pandemic’s onset in 2020 before plummeting to just two in 2021, which industry groups have attributed to the Provider Relief Fund and other COVID-19 assistance policies.

The impending end of those relief payments and a historically difficult year for hospital margins and expenses has industry and public health leaders sounding alarms. Recently the Texas Hospital Association warned that more than a quarter of the state’s rural hospitals are at risk of closure. This came just after Mississsippi’s state health officer said financial struggles threatened more than half of his state’s rural hospitals.

Two key programs bringing financial support to rural hospitals—The Medicare-Dependent Hospital (MDH) program and the Low-Volume Hospital (LVH) program—were set to expire in September but were extended by Congress through Dec. 16. Both are likely to receive additional extensions as lawmakers hash out an omnibus spending bill for the coming year.