Rural community hospital closure and health policy (original) (raw)
Related papers
Patterns of rural hospital closure in the United States
Social Science & Medicine, 1987
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.
Hospital closures and the current healthcare climate: the future of rural hospitals in the USA
Rural and Remote Health, 2016
Hospital closures occur from time to time. These closures affect not only the patients that depend on the hospitals but also the economy in many rural areas. Many factors come into play when a hospital decides to shut off services. Although influencing reasons may vary, hospital closures are likely to be caused by financial shortfalls. In the USA recently, several rural hospitals have closed and many are on the verge of closing. The recent changes in the healthcare industry due to the new reforms are believed to have impacted certain small community and rural hospitals by putting them at risk of closure. In this article, we will discuss some of the highlights of the healthcare reforms and the events that followed, to relate how they may have affected the hospitals. We will also discuss what the future of these hospitals may look like and the necessary steps that the hospitals need to adopt to sustain themselves.
A Comparison of Closed Rural Hospitals and Perceived Impact
2017
From 2010 through 2014, 47 rural hospitals, ceased providing inpatient services in 23 states across the country (“closed”). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”). These closures have affected approximately 800,000 people in the markets with abandoned hospitals and 700,000 people in the markets with converted hospitals. Loss of a rural hospital could impact access to certain necessary health services and is concerning as residents of rural communities are typically older and poorer, more dependent on public insurance programs, and have poorer health status than urban residents. Policy-makers, researchers, and rural residents are concerned and interested in determining why these hospitals are closing, whether the rate will continue to climb, and what effects there could be on local health care providers and the communities they serve.
A Look at Rural Hospital Closures and Implications for Access to Care : Three Case Studies
2016
The number of rural hospital closures has increased significantly in recent years. This trend is expected to continue, raising questions about the impact the closures will have on rural communities’ access to health care services. To investigate the factors that contribute to rural hospital closures and the impact those closures have on access to health care in rural communities, the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute conducted case studies of three hospital closures that took place in 2015: Mercy Hospital in Independence, Kansas; Parkway Regional Hospital in Fulton, Kentucky; and Marlboro Park Hospital in Bennettsville, South Carolina. Two of these hospitals were in states that did not adopt the Medicaid coverage expansion under the Affordable Care Act (ACA) (Kansas and South Carolina), while one of the hospitals was located in a Medicaid expansion state (Kentucky). Key findings include the following:
The Effect of Rural Hospital Closures on Community Economic Health
Health Services Research, 2006
Objective. To examine the effect of rural hospital closures on the local economy. Data Sources. U.S. Census Bureau, OSCAR, Medicare Cost Reports, and surveys of individuals knowledgeable about local hospital closures. Study Design. Economic data at the county level for 1990-2000 were combined with information on hospital closures. The study sample was restricted to rural counties experiencing a closure during the sample period. Longitudinal regression methods were used to estimate the effect of hospital closure on per-capita income, unemployment rate, and other community economic measures. Models included both leading and lagged closure terms allowing a preclosure economic downturn as well as time for the closure to be fully realized by the community. Data Collection. Information on closures was collected by contacting every state hospital association, reconciling information gathered with that contained in the American Hospital Association file and OIG reports. Principal Findings. Results indicate that the closure of the sole hospital in the community reduces per-capita income by $703 ( po0.05) or 4 percent ( po0.05) and increases the unemployment rate by 1.6 percentage points ( po0.01). Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for 2 years following the closure. Conclusions. The local economic effects of a hospital closure should be considered when regulations that affect hospitals' financial well-being are designed or changed.
Numerous rural communities have experienced the loss of their local hospital since the early 1980s. Despite government intervention at the state and federal level, the perception that these closures have caused irreparable harm to the communities and counties where they were once located is ongoing. Much scholarship has been brought to bear on this issue, but little of it has focused on actual events. This paper fills the gaps in prior research, while focusing on the outcomes observed only in Texas. This research builds on the comparative analysis approach used in another study regarding rural hospital closures between 1984 and 1988. Selected economic indicators from 24 rural Texas counties that lost their local hospital are compared with those from a group of counties that experienced no such closures. Comparison counties were selected based on a set of accepted demographic variables. Economic effects were then observed at one and ten years after closure. Quantitative analysis was used to determine the significance of the economic effects experienced by closure counties. The research hypothesis states that hospital closures negatively impact the local economies of the counties where they were once located, in both the short-term and the long-term. Actual results, however, pointed to the contrary. There was no significant difference observed between the counties with hospitals and those without for any of the economic indicators that were tested. Also, the research revealed no significant difference between the two groups in either the short-term or the long-term. The outcomes observed here mimic the results obtained in the prior study, despite the differences between Texas county data and data aggregated at the national level. A smaller unit of analysis and a focus on effects other than the financial might make a more meaningful approach.
State health policy and rural hospitals
The Journal of rural health, 1992
Many rural hospitals are experiencing dificulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low-cost ways those rural hospitals that are ready to change or that, with kelp, will be ready to make suck operational changes as service reconfiguration, afiliations, and working agreements with other health care organizations to continue and improve local access to health care.
Financial Strategies and Initiatives for Preventing Rural Hospital Closure
2018
Financial Strategies and Initiatives for Preventing Rural Hospital Closure by Chinue Uecker MBA, Marquette University, 2008 BS, University of Illinois at Chicago, 1998 BA, University of Chicago, 1997 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University August 2018 Abstract In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital’s financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital’s financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decisionmaking framework supported the study because top leaders make decisions that affect the organization’s health a...
The Journal of Rural Health, 1999
The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include dificulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may ofer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.
Small, Rural Hospitals: A Fight for Survival
Declining reimbursements, resulting from the 1997 Balanced Budget Act (BBA), have placed an enormous strain on small, rural hospitals that are typically dependent on Medicare patients for the majority of their revenue. Under the BBA, new managed care and private options are available, payments to hospitals are reduced, Part B premiums are increased, and a prospective payment system (PPS) is authorized for outpatient, home health, and skilled nursing services. The Balanced Budget Refinement Act of 1999 (BBRA) attempts to rectify some of the reductions in reimbursement. Nonetheless, to take advantage of the BBRA and to address declining reimbursements from other sources, rural hospitals should expand outpatient services, embrace telemedicine and telehealth initiatives, and actively seek alternative funding.