Study: Rural hospital closures over latest decade affected more Black and Hispanic residents

A new study found that over the last decade, rural counties that had a hospital shut its doors had a higher share of Black and Hispanic residents and greater shares of income inequality compared to prior decades.

The study, recently released by the University of North Carolina Cecil G. Sheps Center for Health Services Research, explored socioeconomic, demographic and other health system characteristics for rural counties that had and did not have facility closures from 1990 to 2020. The research comes as the Biden administration is pressing to address sources of health equity gaps.

Researchers found that the percentage of Black residents in a county that had a rural hospital close was 5% from 2010 to 2020. This was much higher compared to 2000 to 2009, when 0.7% of U.S. Black residents were in a county that had a closure, and in 1990 to 1999, when the percentage was 0.4%. 

“This suggests that rural hospital closures between 2010 and 2020 may have had a more racially disparate impact compared with previous decades,” the study said. 

Drivers of this pattern include the high clustering of rural hospital closures in the South from 2010 to 2020, a region where most of the states did not expand Medicaid after passage of the Affordable Care Act. 

Another driver was the “growing concentration of closures in rural counties that neighbor metro counties,” the study said.

Researchers found that a higher share of Hispanic residents were also more impacted by hospital closures over the last decade. From 2010 to 2020, the percentage of U.S. Hispanic residents in a county that faced a closure was 3.9% compared with 1.6% from 2000 to 2009 and 0.7% from 1990 to 1999.

The study did note the number of Hispanics in rural counties increased from 2010 to 2020. 

Rural hospital closures also heavily impacted counties with greater levels of income inequality. For example, the unemployment rate for rural counties that experienced a close from 1990 to 1999 was 6.3%, and that increased to 10.2% over the latest decade. 

The median income in affected counties was $44,360 from 2010 to 2020, compared to $45,381 from 1990 to 1999. 

Researchers also discovered that from 1990 to 2020, the counties which had a closure were “increasingly likely to be primary care and dental health service professional shortage areas prior to the closure of a hospital within their borders.”

The study comes as the Biden administration is searching for ways to improve health equity, especially in rural and underserved areas. 

The Center for Medicare and Medicaid Innovation released a strategic refresh earlier this year that calls for health equity to be a pillar of its payment models going forward. The new strategy also aims to make it easier for rural providers to participate in value-based care, including providing upfront investments to offset the higher cost for setting up a value-based care system.