Rural Roundup: Closing Rural Hospitals Leads to Higher Mortality Rates

The mortality rate in a rural community that loses a hospital increases by an average of 5.9 percent, researchers at the University of Washington report. / City celebrates its role in desegregation 63 years later / Ethanol manufacturers push back against Trump’s exemptions for big oil / Trade war hurts rural wireless carriers. / USDA offers lower-than-expected buyouts to research employees.

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When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.

The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.

In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates.

But when the hospitals were divided between rural and urban, the researchers found a distinct difference. Mortality rates in rural areas increased 5.9 percent. This matched earlier studies, which found mortality rates increasing from 3 to 10 percent after a rural hospital closes.

About 15 percent of all U.S. hospitals have closed since 1990, and the rate of rural hospital closures has increased since 2010. “From an efficiency  standpoint,” the researchers wrote, “rural hospitals exiting the market seems inevitable….”

But rural hospital closures “can have enormous negative implications for patient welfare.” When a rural hospital closes, transportation times to health care increase more for rural residents. But distance isn’t the only problem. The lack of public transportation in rural areas makes it harder for people, especially the elderly, to get to the closest hospital.

Also, when a hospital closes, there is an outmigration of healthcare professionals, diminishing access to care across the board. The researchers note that when a large hospital system in Kansas, Kentucky, and South Carolina closed, local physicians were offered jobs in urban areas. “(P)hysician relocation due to hospital closure exacerbates existing recruitment difficulties and systemic workforce shortages in rural areas,” the paper reports.

There is a cascade of problems that comes with rural hospital closures. Transportation times increase. Physicians are harder to find. Waiting times increase. Facilities that remain are overcrowded. This combination of factors leads to higher death rates.

— Bill Bishop

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Most Americans equate school integration in the South with the city of Little Rock, Arkansas. But the first public school in the South to integrate was in the small town of Clinton, Tennessee, according to the Encyclopedia of Tennessee.

On Monday, residents of Clinton honored the 12 African American students who integrated Clinton High School on August 26, 1956, more than a year before Little Rock desegregated.

In 1956, the Clinton 12, as they came to be known, entered the high school without incident. Violence and animosity came later, however, as is documented in this Edward R. Murrow “See It Now” report shot in December 1956.

Clinton’s population was only 4,000 at the time of integration – compared to Little Rock, which had more than 100,000 residents in the 1950s. The surrounding Anderson County, Tennessee, was largely rural at the time, with the exception of Oak Ridge (home of Oak Ridge National Laboratory) and coal camps on the northern end of the county. Today, the county is part of the Knoxville metro area.

In the last 20 years, the city of Clinton has come to embrace its Civil Rights heritage. The city commissioned a documentary, commemorative monument, and museum about the events of 1956. The celebration of the 63rd anniversary of school integration was organized by the county tourism office.

–Tim Marema

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A message from the Rural Assembly

Small towns and rural businesses will suffer most from President Trump’s decision to reduce the supply of ethanol-blended fuel, according to Donnelle Eller at the Des Moines Register.

“It’s a train wreck out there,” said Nick Bowdish, CEO of Elite Ethanol in Atlantic, Iowa, referring to economic conditions for ethanol refineries.

The Trump administration has exempted 85 fuel refineries from purchasing 4 billion gallons of renewable fuel. (The Obama administration exempted fewer than 10.) The exemptions mean a 1.4-billion-bushel reduction in demand for corn. That means more uncertainty for farmers who are already hurting from hog and soybean tariffs.

“If people connected to agriculture decide to vote for the president, they’re just voting to cut off their own economic prosperity,” Bowdish said.

Nationwide, 15 ethanol plants are closing and others are cutting production. That means job cuts:

“Seventy percent of U.S. [ethanol] plants are burning cash. … And you can only burn through cash for so long,” said Monte Shaw, executive director of the Iowa Renewable Fuels Association. The remaining 30% of ethanol plants are “dog-paddling, trying really hard to keep their noses above water,” he said.

In the past, ethanol exemptions were granted to smaller refineries facing economic pressure. Under Trump, the Environmental Protection Agency has granted exemptions to some of the nation’s largest oil companies, including ExxonMobile and Chevron Corp.

Iowa Republican Senator Chuck Grassley, who is heading up Trump’s reelection campaign in Iowa, did not mince words.

“They screwed us,” he said on an Iowa Public Television news show. “What’s bad isn’t the waiver. It’s that it’s being granted to people who really aren’t (experiencing) hardship.”

— Tim Marema

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The country’s trade war with China is affecting more than just agriculture in rural communications. The Washington Post reports that the Trump administration’s intention to blacklist products from Huawei will hurt rural wireless carriers.

A ban on Huawei equipment will require wireless carriers to spend up to $1 billion to switch out equipment. Rural companies originally bought the Huawei equipment because it was cheaper. Now they are searching for replacement parts and systems.

The Trump administration gave carriers a 90-day reprieve from an outright ban on Huawei equipment, but companies say that is not really enough time to make the switch. Or find a way to pay for the new components.

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USDA employees who leave the department before two research agencies relocate from Washington, D.C., to the Kansas City area will receive a $10,000 separation package, not the maximum allowable $25,000 payout, reports Nicole Ogrysko at Federal News Network. 

The lower payout offer is the result of the volume of requests for the separation agreements, according to a USDA document that Ogrysko obtained.

USDA offered a Voluntary Separation Incentive Payment (VSIP) to 43 employees of the Economic Research Service and 48 employees of the National Institute of Food and Agriculture. USDA is also offering an undisclosed number of early retirement payouts.

In July USDA announced that 58 percent of the ERS employees who were offered reassignment to Kansas City declined. At NIFA, 67% of the agency’s employees who are to be relocated declined to do so.

 

A message from the Rural Assembly

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