United States Government Accountability Office (GAO), December 2020
What GAO Found
GAO found that when rural hospitals closed, residents living in the closed hospitals’ service areas would have to travel substantially farther to access certain health care services. Specifically, for residents living in these service areas, GAO’s analysis shows that the median distance to access some of the more common health care services increased about 20 miles from 2012 to 2018. For example, the median distance to access general inpatient services was 3.4 miles in 2012, compared to 23.9 miles in 2018—an increase of 20.5 miles. For some of the less common services that were offered by a few of the hospitals that closed, this median distance increased much more. For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services.
GAO also found that the availability of health care providers in counties with rural hospital closures generally was lower and declined more over time, compared to those without closures. Specifically, counties with closures generally had fewer health care professionals per 100,000 residents in 2012 than did counties without closures. The disparities in the availability of health care professionals in these counties grew from 2012 to 2017. For example, over this time period, the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents.
Median Distance in Miles from Service Areas with Rural Hospital Closures to the Nearest Open Hospital that Offered Certain Health Care Services, 2012 and 2018:
- General Inpatient
- 2012: 3.4
- 2018: 23.9
- Emergency Department
- 2012: 3.3
- 2018: 24.2
- Alcohol or drug
- 2012: 5.5
- 2018: 44.6
- Coronary Care Unit
- 2012: 4.5
- 2018: 36.1
By Don McCanne, M.D.
The declining numbers of rural hospitals have been of concern for many years. Of perhaps greater concern is the decline in the availability of health care providers in counties where rural hospitals closed. Look particularly at the extra distance that must be traveled if you are having a heart attack. That delay could be a matter of life or death.
One of the advantages of a single payer improved Medicare for All program is that it includes regional planning that is based on need. If rural hospitals and their facilities are needed, then they should be available, regardless of cost.
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