“We’re Closed, Call 911”: Community Effects and Perceptions of Rural Hospital Closures

Abstract

Across the United States, rural hospitals have been closing at an alarming rate since 2010. This trend is expected to persist, which raises policy-relevant questions about the effects of closures on their surrounding rural communities. This thesis builds on previous studies and proposes a new framework for assessing the effects of rural hospital closures. It uses a combination of t-tests and a difference-indifferences regression model to quantify the relationship between rural hospital closures and seven health outcomes tailored to the distinct challenges faced by rural hospitals and their communities. These variables include: the number of primary care physicians and mental health providers in a given community, the number of self-reported days of physical and mental unhealth, the uninsured rate, the premature death rate, and the hospitalization rate. The statistical model shows that rural hospital closures are associated with a significant decrease in the number of mental health providers in a county, adding to the pre-existing problems of access to mental health care in rural areas. Closures were not significantly associated with a change in days physically or mentally unhealthy, uninsured rates, primary care providers, or premature death rates. The full impact of rural hospital closures may require a longer time frame of analysis to be observed and measured. Furthermore, this thesis also discusses a nationwide implementation of Medicaid expansion as a policy option to strengthen rural health systems and ultimately prevent rural hospital closures. Using a quantitative textual analysis of local news coverage, this thesis studies community perception of rural hospital closures in an attempt to uncover paths to action on Medicaid expansion. The results show that communities frequently respond with anger, sadness, fear, and disgust about their state’s decision not to expand Medicaid and its causal effect on their hospital’s closing. Recent state examples typify the way that the issue of rural hospital closures and its corresponding public response are prime options for mobilization to lead to Medicaid expansion. This thesis concludes with reflections on trends in the rural health landscape, offering proposals for further study to expand the body of research for relevant evidence-based policy decisions. Using the insights from the preceding analysis, it comments on implications for health policy action in the future.