Rural hospital closings lifting mortality rates: study

September 20, 2019
by Thomas Dworetzky, Contributing Reporter
As rural hospitals close, mortality rates go up, says a new study.

With over 100 such facilities shuttered since 2010 and another 430 in jeopardy of doing the same, University of Washington researchers, who looked at 92 of them, have found that such closings are leading to a 5.9 percent rise in mortality rates.

“Rural closings increase travel times for patients, and lead to outmigration of health care professionals post-closure, severely dismembering patient access to care and exacerbating social disparities in health outcomes,” researchers Kritee Gujral and Anirban Basu wrote in their study, published online by the National Bureau of Economic Research.

That extra time can prove disastrous in emergencies like heart attacks and car crashes.

"There’s a golden hour of getting care in that first hour of trauma," Dr. Nancy Dickey, president of the Rural and Community Health Institute at Texas A&M, told NBC News, noting that, "if you don't get care in that time, it can have a negative impact on morbidity as well as mortality."

One contributor to these health facility closings: there is often a larger number of under- or uninsured in rural areas.

“These problems are exacerbated in rural areas, especially due to the recent economic downturns and job losses leading to outmigration and shrinking populations, leaving behind populations that are older, sicker and more reliant on Medicaid and Medicare,” the researchers wrote.

Politics also often compounds the financial strains on these institutions. In a 2018 study from the University of Colorado, published in Health Affairs, researchers stated, “we found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion.”

To date, 14 states have refused Medicaid expansion, according to NBC.

"So there is evidence to show that is true," George Pink, deputy director of the Rural Health Research Program at the University of North Carolina's Sheps Center, told the news site, regarding that study. But that feeling is not universal, he added, "anecdotally, I present a lot around the country and have found CEOs of hospitals are of mixed opinion. Some hospitals in California believe Medicaid expansion and the Affordable Care Act was the savior of many rural hospitals — you find diehard believers out there. CEOs in other states, even states that have expanded Medicaid, are less sanguine."

Issues other than those concerning health appear to play a major role. "Your conclusion on this issue often depends on what state you’re in," Pink told NBC, "and the political ideology of the person you’re talking to."

Regardless of politics, the healthcare challenge remains. Advised Dickey, "the kinds of things you can do in a small hospital have shrunk down substantially, and we have not taken the time and energy to say, ‘How do we revamp how we deliver health care when so much that we deliver is high-tech care?’”

In February, a Navigant Healthcare study found that one in five rural hospitals in the U.S. are at high risk of closing, yet 64 percent of them are crucial to the health and economic success of their communities.

The study evaluated over 2,000 rural hospitals around the country and found that 21 percent are at a high risk of closing based on their total operating margins, days cash on hand and debit-to-capitalization ratio. That means that 430 hospitals in 43 states that employ 150,000 individuals are in danger of shutting down.