Speak Your Piece: The True Cost of Rural Hospital Closures
Rural hospitals are closing at an alarming rate in the U.S., and the losses may be worse than the sum of all the parts.
Editor’s Note: This article is reprinted with permission from the National Rural Health Association’s Rural Roads summer 2016 magazine.
After 66 years in business, my hometown hospital recently closed its doors to patients. Gone is the emergency room, skilled nursing facility, lab, radiology, and physical therapy services — as well as 67 full-time jobs.
Meanwhile, in the past six years. 72 rural hospitals in the U.S. have closed, including nine already in 2016.
One in three rural hospitals is at risk of closing, and according to the National Rural Health Association’s Journal of Rural Health, closure rates have increased 600 percent in the put five years.
Across the country, small towns are literally losing their lifelines.
What gets lost in this story is what these closures mean lot the towns whose hospitals are shuttered. Sure. It’s obvious that jobs, public safety and community institutions are at stake. But what are we really doing by letting that institutions die? Where is this all going?
I was fortunate enough to have been raised in a town of 2,000, and I’ve also had the chance to see the world beyond its horizons. My first job at age 12 was cleaning the house where the emergency room physicians stayed while they took call for our E.R.
I’ve also worked as an EMT on our local ambulance and a medical assistant in our rural health clinic. I went to college and earned a master’s degree with research focused on rural physician recruitment before pursuing medical school and a family medicine residency. My parents and extended community still live in the small town where I grew up.
I have been shocked by the latest sates of hospital closures, which are rivaled historically only by the closure of 440 U.S. hospitals in the 1980s resulting from changes to how Medicare paid for their services.
In addition to my hometown hospital, five others that I have worked at or gotten to know through my research have either dosed or are teeming on the brink.
The very institutions that trained me and cared for the people I love are facing extinction if nothing changes. And so I return to this central question: What does it really mean for a town to lose its hospital?
The first loss is a sense of safety and security, one that is backed up by hard evidence. A 2014 study in Health Affairs showed that the death rates for patients in towns where the ER recently closed increased 5 percent across the board and 15 percent when patients had a heart attack or stroke.
This study didn’t analyze data on major trauma, where the time between getting injured and receiving care is even more critical. Heaven forbid one of my own parents suffered a stroke or a heart attack; they would likely be outside the window for brain-or heart-saving medications with their current travel time to a facility with an ER.
Any patient with seizures, anaphylaxis or any other life-threatening medical condition would literally have to consider moving out of town to a place with better access to care. In Tonopah, Nevada, a recent hospital closure means that residents have a 110-mile drive across state lines to the nearest emergency room.
A shuttered hospital is also a near-death sentence to many small-town economies. On average, according to the Health Services Research Journal, closure of a local hospital reduces per capita income by $703 and increases unemployment by 1.6 percent. Undoubtedly, the more remote the community, the greater the effect, since lost jobs can’t be replaced by people driving to other nearby communities to find work.
Hospital closures also drive down property values, make towns far less attractive to retirees with their often complex health problems, and gut the local professional community, taking a hit on local pharmacies and other local health-related businesses as well. My hometown pharmacy was in the process of being sold when the hospital recently closed, and now that sale is anything but sure.
With doctors and other clinicians frequently employed by hospitals, the loss of a hospital can also mean the loss of nearly all medical care in that community. A patient’s doctor for the past five, 10 or 20 years can move on despite a heartfelt commitment to rural health and his or her patients. An ambulance service can disappear, leaving residents to drive deathly ill friends and family members to the hospital without any medical support.
Providers who cost tens of thousands of dollars and months or years to recruit can all be gone within weeks. Without a hospital to support them, many move on to more sustainable medical communities where they have more resources and are less isolated.
Finally, as in my case, hospitals are frequently a key provider of career opportunities and a path to the middle class for rural people who often have few options besides leaving town to be educated elsewhere. They are sources of the “homegrown” rural clinicians and health professionals that every government program is struggling to produce and retain.
I have seen dozens of classmates and friends start as hospital cafeteria employees or laundry workers and rise through the ranks of CNAs, EMTs, nurses and physicians during their careers. Few other institutions in small towns offer similar possibilities. By undercutting the hospitals that foster this process, we are reversing decades of work to improve the supply of rural providers and other health professionals throughout the country.
Above all, as a nation, we have stood up again and again to support equality, access and fairness. Allowing the current wave of rural hospital closures to continue defies our most basic values. It widens the gaps in a tiered system of health care where we support urban hospitals with our legislative and regulatory efforts and leave rural hospitals to struggle and die.
This is not acceptable. Please join me in supporting rural hospitals and the 62 million Americans who depend on them.