Rural Hospital Closures Research Articles

Rural community hospital closure and health policy

Closure of rural community hospitals in the U.S.A. is a growing and important trend with serious implications for rural communities and the overall health care system. This study analyzes characteristics of all U.S. rural hospitals that closed between 1980 and 1986. Variables correlated with risk of closure for-profit ownership status, non-government not-for-profit ownership status, number of other hospitals in the county, presence of a nursing or other long-term care unit, few facilities and services offered, lack of accreditation by the Joint Commission of Accreditation of Hospitals, lack of membership in a multihospital system - indicate that a rural hospital's survival depends upon its ability to compete and adapt in a volatile, competitive health care marketplace. Five policy options are discussed: changes in Medicare payments, expansion of the number of hospitals designated as Sole Community Hospitals, the use of swing beds, establishment of state offices of rural health, and short-term federal and state grants. Allowing hospitals the flexibility to adapt and compete, while ensuring adequate quality health care to rural residents, is suggested as the priority in rural health policy.

Patterns of rural hospital closure in the United States

This is a case-control study of rural hospitals which closed between 1970 and 1980. Nonmetropolitan hospitals which closed were matched with a comparable set of hospitals which remained open, yielding 148 closures (cases) and 310 controls. Univariate and multivariate analyses indicate that closed hospitals differ from open hospitals in their internal characteristics, and that their geographical service areas also are significantly different. At the multivariate level, the most significant variables, as determined by stepwise discriminant analysis, are the ownership (profit) status of the hospital, occupancy rate, competitive beds within the county, scope of service, and county population change during the preceding decade. The nature of the discriminant functions differed between counties which were adjacent to metropolitan areas, and those which were not adjacent to metropolitan areas. Closed hospitals differ from open hospitals, as ascertained by standard data sources. Hospital closure reflects the interaction of internal hospital characteristics, and the characteristics of the hospital's service area.

Benefit-Cost Analysis and Medical Care Delivery System Change

This article utilizes benefit-cost analysis to evaluate a hypothetical rural hospital closure. The estimated benefits were found to be extremely sensitive to assumptions concerning the nature of hospital marginal cost curves and less sensitive to the proportion of the hospital bill assumed to be paid directly by consumers. The net benefits of a hospital closure were largest in the case where hospital alternatives were small, under-utilized facilities. The analysis suggests that when evaluating medical delivery system change, benefit-cost techniques can be useful to policymakers in structuring the problem and identifying key assumptions. However, theoretical considerations in combination with data and resource requirements will limit its usefulness as an applied health-planning tool.

Closure of Rural Hospitals

Closure of Rural Hospitals