Carolina Curious: Why Are So Many Rural Hospitals Closing And What Happens After They Do?

Rural hospitals across the country are closing at an alarming rate - over 80 since 2010. And a majority of these are located in the South.

One WFDD listener asked: why are so many small town hospitals being forced to close?

To answer that question, in the latest installment of our series Carolina Curious, WFDD's Bethany Chafin speaks with Dr. George Pink of the North Carolina Rural Health Research Program. He outlines what happens before and after a rural hospital leaves a community. 

Three broad categories of factors that are explaining rural hospital closures:

1. The market: small, declining populations; high unemployment rates; increasing numbers of uninsured and underinsured patients; and competition.

2. Hospital challenges: low daily census (average daily patients), difficulty maintaining physician coverage, deteriorating physical facility. 

3. Financial reasons (most important): high and increasing charity care and bad debt, insufficient cash flow, and typically these hospitals have been unprofitable for many years.

On what happens after a rural hospital closes:

1. Residents lose direct access to the hospital and the inpatient care they were receiving locally, so now they must travel to another town. 

2. It's not uncommon for many other kinds of health care services to leave the town as well - clinics, perhaps physician group practices, primary care facilities, for example. And that leaves the town even more depleted of health care resources, far beyond the original hospital itself closing. 

3. [There's a] loss of employment and economic benefits that the hospital, which is typically the largest employer in a small town, brings to the town. When you lose the employment and you lose some of the associated health services that go with the hospital, that has a multiplier effect economically speaking. It reinforces a sort of death spiral for many towns. Many businesses won't locate new plants in towns without a hospital. One town was having trouble recruiting teachers because teachers tend to be young [and] of childbearing age, or parents, and moving to a place where they need health care.

Dr. Pink on hospitals that aren't closing but are being absorbed by larger health care networks:

Generally speaking, rural communities benefit in many ways. One is access to capital. Many rural hospitals do not have the financial means to access the funds necessary to acquire new equipment, repair the building, maintain services and so on. The larger health system is an important source of that kind of capital. Quality programs, specialist care - I've been to many communities where, after the system acquired the smaller hospital, there are now regular specialist visits...a surgeon comes in or a psychiatrist or another specialist. Those are kinds of clinics that were never held before the hospital was acquired by the system. On the downside, there are some communities that report slower decision making by the system that owns the hospital and lack of local control over decision making is another complaint you hear.